SHM Converge Scientific Abstract ePoster Gallery-Epidural Blood-Patch for Treatment of Intracranial Hypotension in Jehovah's Witness

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This case report describes a 36-year-old Jehovah’s Witness woman with postural headaches and double vision caused by left abducens (cranial nerve VI) palsy from spontaneous intracranial hypotension. Although abducens palsy is more commonly associated with increased intracranial pressure, it can also occur with intracranial hypotension, typically due to cerebrospinal fluid (CSF) leakage.<br /><br />The patient had a history of multiple childbirths, including seven epidural anesthetics, which raised suspicion for a CSF leak. Her neurological exam was otherwise normal except for the left lateral rectus palsy. Head CTA was unremarkable, but MRI of the brain showed diffuse smooth dural thickening and enhancement, findings consistent with intracranial hypotension. Whole-spine MRI also showed dural enhancement and extradural fluid collections, though no exact leak site was identified.<br /><br />Initial conservative treatment with caffeine and salt tablets did not significantly help. The team then considered an epidural blood patch, a treatment often used when symptoms persist and which can lead to rapid improvement. Because the patient was a Jehovah’s Witness, her beliefs needed to be considered. After discussion with her community elders, an autologous epidural blood patch was deemed acceptable.<br /><br />Following two blood patches, the patient’s headaches improved significantly and her diplopia improved somewhat before discharge. The report emphasizes that spontaneous intracranial hypotension should be considered in patients with postural headaches and cranial nerve VI palsy, that MRI and especially CT/MR myelography can help identify CSF leaks, and that epidural blood patch may be effective even in some Jehovah’s Witness patients.

Asset Subtitle

Muhammad U. Javed

Meta Tag

Author List Lauren Stogner, Maymona Dulli, Muhammad U. Javed, Sami Tahhan

Category Clinical Vignettes

Concept Abducens Nerve Palsy

Concept Spontaneous Intracranial Hypotension

Concept Orthostatic Headache

Concept Spinal CSF Leak

Concept Diplopia

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School at Old Dominion University

Presenting Author Muhammad U. Javed

Track Adult

Keywords

spontaneous intracranial hypotension

abducens palsy

cranial nerve VI

postural headache

diplopia

cerebrospinal fluid leak

epidural blood patch

MRI dural enhancement

Jehovah's Witness

CSF leak

Abducens Nerve Palsy

Spontaneous Intracranial Hypotension

Orthostatic Headache

Spinal CSF Leak

Diplopia