This protocol applies to patients with spontaneous intracranial hypotension whose initial epidural blood patch (EBP) treatment has not produced the expected response, necessitating a defined next clinical step.
Initial management consisted of epidural blood patch as first-line treatment. Escalation to this protocol is triggered when that EBP fails to achieve at least 50% improvement of symptoms by 3 months — the threshold at which complete remission might otherwise be expected in a proportion of patients.
The next step involves a further blood patch procedure. Evidence suggests that a specific technical approach to the patch, when performed in experienced hands, may yield better outcomes than a standard repeat. The complete structured regimen is available via the link below.
DOI: 10.1212/CPJ.0000000000200290