Abstract
Purpose
This case report describes the use of electrical epidural stimulation (Tsui test) to confirm accurate placement of a thoracic epidural catheter when administering an epidural blood patch for headache management in a patient suffering from spontaneous intracranial hypotension.
Clinical features
A 41-yr-old female presented to the Chronic Pain Clinic with a history of postural headache symptoms worsening in severity over several years. Two previous blood patches performed at T11-12 and T10-11 respectively provided short-term relief only. The presumed diagnosis of a spontaneous dural tear was confirmed by a nuclear flow test to be at T2-T4. The epidural site was accessed at T6 with a Tuohy needle. To accurately place the epidural blood patch at the level of the dural tear, the Arrow catheter with electrode adapter was advanced under nerve stimulation guidance to T4. Te n millilitres of autologous blood injected through the catheter was confirmed on magnetic resonance imaging, one hour postprocedure, to lie between T3 and T9. Sustained headache relief was achieved.
Conclusion
The use of electrical stimulation guidance may be useful when precise epidural blood patch placement is required.
Résumé
Objectif
Décrire ľusage de la stimulation électrique épidurale (test Tsui) pour confirmer la bonne position ďun cathéter épidural thoracique dans le traitement de céphalées au moyen ďun colmatage sanguin épidural chez une femme souffrant ďhypotension intracrânienne spontanée.
Éléments cliniques
Une femme de 41 ans s’est présentée à la Chronic Pain Clinic pour des symptômes de céphalées posturales de sévérité progressive depuis quelques années. Deux colmatages sanguins antérieurs réalisés à T11-12 et à T10-11 n’avaient produit qu’un soulagement temporaire. Une rupture durale spontanée a été présumée, et confirmé en médecine nucléaire par un test de débit é T2-T4. Ľaccès épidural à T6 s’est fait avec une aiguille Tuohy. Pour un colmatage sanguin épidural au niveau exact de la rupture durale, le cathéter Arrow, avec raccord pour ľélectrode, a été guidé par neurostimulation jusqu’à T4. Ľinjection de dix millilitres de sang autologue dans le cathéter a été confirmée entre T3 et T9 par les images de la résonance magnétique, une heure plus tard. Un soulagement prolongé des céphalées a suivi.
Conclusion
La stimulation électrique peut guider la mise en place précise ďun colmatage sanguin épidural nécessaire.
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An erratum to this article is available at http://dx.doi.org/10.1007/BF03021640.
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Morley-Forster, P.K., Abotaiban, A., Ganapathy, S. et al. Regional Anesthesia and Pain Targeted thoracic epidural blood patch placed under electrical stimulation guidance (Tsui test). Can J Anesth 53, 375–379 (2006). https://doi.org/10.1007/BF03022502
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DOI: https://doi.org/10.1007/BF03022502