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Is It a Rational Choice to Treat with Lumbar Epidural Blood Patch Headache Caused by Spontaneous Cervical CSF Leak?

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, low CSF pressure and diffuse pachymeningeal enhancement on brain magnetic resonance imaging (MRI) (1, 2). Atypical cases with normal CSF pressure (3), normal cranial MRI (4) and without postural headache (5) have also been reported. SIH generally results from spinal spontaneous CSF leakage, sometimes associated with underlying connective tissue disorders (6, 7). Treatment is usually conservative. Sometimes an autologous epidural blood patch (AEBP) at the site of CSF leakage may be necessary (8). We describe a patient with a spontaneous cervical CSF leak treated with autologous lumbar epidural blood patch (far from the site of the CSF leak).