Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, nausea, vomiting, and blurred vision. Rarely, behavioral or consciousness changes, parkinsonian symptoms, and/or coma manifest. The use of an epidural blood patch (EBP) is generally considered for sealing a cerebrospinal fluid (CSF) leak. Herein we report a case of progressive altered consciousness due to severe SIH that was managed with an EBP. Brain magnetic resonance imaging depicted diffuse pachymeningeal enhancement with bilateral subdural hemorrhage, consistent with SIH. She was diagnosed with brain sagging due to SIH. An EBP was performed at C7- T1 and she was discharged with improvement; however, 1 day after discharge she visited the emergency room exhibiting aggressive behavior and cognitive changes. Whole spine magnetic resonance imaging revealed CSF leakage at T1-T5, and she was diagnosed with recurred SIH with SDH. EBP was performed at T2-T3 level with autologous blood. Follow-up myelography depicted improvement of the CSF leakage at the T spine level. Targeted EBP may be suitable for alleviating severe SIH-induced confusion and altered consciousness.

Keywordsaltered consciousness, epidural blood patch, headache, spontaneous intracranial hypotension