Epidural Blood Patch

  • Sameh Michel HakimEmail author
  • Samer N. Narouze


Autologous epidural blood patch (EBP) is a useful technique that may be employed for treatment of postural headaches resulting from cerebrospinal fluid (CSF) leak. The main indications for EBP are postdural puncture headache or headache associated with spontaneous intracranial hypotension. EBP may be indicated for persistent CSF leak after invasive procedures or surgery on the spine. Prophylactic EBP after accidental dural puncture is hardly warranted at present. When autologous EBP is not feasible, fibrin glue may serve as an alternative. EBP is generally safe but may rarely be attended with serious complications.


Fibrin Glue Acquire Immune Deficiency Syndrome Epidural Space Autologous Blood Intracranial Hypotension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Harrington BE. Meningeal puncture headache. In: Neal JM, Rathmell JP, editors. Complications in regional anesthesia and pain medicine. Philadelphia: Saunders Elsevier; 2007. p. 75–87.Google Scholar
  2. 2.
    Gormley JB. Treatment of post spinal headache. Anesthesiology. 1960;21:565–6.Google Scholar
  3. 3.
    Watanabe L. Epidural blood and fibrin patches. In: Mathis JM, editor. Image-guided spine interventions. New York: Springer; 2004. p. 322–33.Google Scholar
  4. 4.
    DiGiovanni AJ, Dunbar BS. Epidural injections of autologous blood for postlumbar-puncture headache. Anesth Analg. 1970;49:268–71.PubMedGoogle Scholar
  5. 5.
    Crawford JS. Experiences with epidural blood patch. Anaesthesia. 1980;35:513–5.PubMedGoogle Scholar
  6. 6.
    Duffy PJ, Crosby ET. The epidural blood patch. Resolving the controversies. Can J Anaesth. 1999;46:878–86.PubMedGoogle Scholar
  7. 7.
    Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev. 2010;(1):CD001791.Google Scholar
  8. 8.
    Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50:1144–52.PubMedGoogle Scholar
  9. 9.
    Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91:718–29.PubMedGoogle Scholar
  10. 10.
    Morewood GH. A rational approach to the cause, prevention and treatment of postdural puncture headache. Can Med Assoc J. 1993;149:1087–93.Google Scholar
  11. 11.
    Levine DN, Rapalino O. The pathophysiology of lumbar puncture headache. J Neurol Sci. 2001;192:1–8.PubMedGoogle Scholar
  12. 12.
    Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440–2.PubMedCentralPubMedGoogle Scholar
  13. 13.
    Hannerz J, Ericson K, Bro Skejø HP. MR imaging with gadolinium in patients with and without post-lumbar puncture headache. Acta Radiol. 1999;4:135–41.Google Scholar
  14. 14.
    Cook MA, Watkins-Pitchford JM. Epidural blood patch: a rapid coagulation response. Anesth Analg. 1990;70:567–8.PubMedGoogle Scholar
  15. 15.
    DiGiovanni AJ, Galbert MW, Wahle WM. Epidural injection of autologous blood for postlumbar-puncture headache II. Additional clinical experiences and laboratory investigation. Anesth Analg. 1972;51:226–32.PubMedGoogle Scholar
  16. 16.
    Harrington BE. Postdural puncture headache and the development of the epidural blood patch. Reg Anesth Pain Med. 2004;29:136–63.PubMedGoogle Scholar
  17. 17.
    Kroin JS, Nagalla SK, Buvanendran A, McCarthy RJ, Tuman KJ, Ivankovich AD. The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model. Anesth Analg. 2002;95:423–9.PubMedGoogle Scholar
  18. 18.
    Beards SC, Jackson A, Griffiths AG, Horsman EL. Magnetic resonance imaging of extradural blood patches: appearances from 30 min to 18 h. Br J Anaesth. 1993;71:182–8.PubMedGoogle Scholar
  19. 19.
    Bezov D, Ashina S, Lipton R. Post-dural puncture headache: part II – prevention, management, and prognosis. Headache. 2010;50:1482–98.PubMedGoogle Scholar
  20. 20.
    Loeser EA, Hill GE, Bennett GM, Sederberg JH. Time vs. success rate for epidural blood patch. Anesthesiology. 1978;49:147–8.PubMedGoogle Scholar
  21. 21.
    Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P, Seebacher J. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95:334–9.PubMedGoogle Scholar
  22. 22.
    Banks S, Paech M, Gurrin L. An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients. Int J Obstet Anesth. 2001;10:172–6.PubMedGoogle Scholar
  23. 23.
    Tobias MD, Pilla MA, Rogers C, Jobes DR. Lidocaine inhibits blood coagulation: implications for epidural blood patch. Anesth Analg. 1996;82:766–9.PubMedGoogle Scholar
  24. 24.
    Kohrs R, Hoenemann CW, Feirer N, Durieux ME. Bupivacaine inhibits whole blood coagulation in vitro. Reg Anesth Pain Med. 1999;24:326–30.PubMedGoogle Scholar
  25. 25.
    Lee C-C, Huang G-S, Lin T-C, Lee J-C, Wong C-S. An epidural blood patch relieves unilateral postdural puncture tinnitus in a post-caesarean section parturient. J Med Sci (Taipei). 2007;27:29–32.Google Scholar
  26. 26.
    Nakaya M, Morita I, Horiuchi M. Recurrent hearing loss after myelography treated with epidural blood patch. Auris Nasus Larynx. 2005;32:399–401.PubMedGoogle Scholar
  27. 27.
    Lybecker H, Andersen T, Helbo-Hansen HS. The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache. J Clin Anesth. 1995;7:457–64.PubMedGoogle Scholar
  28. 28.
    Dunbar SA, Katz NP. Failure of delayed epidural blood patching to correct persistent cranial nerve palsies. Anesth Analg. 1994;79:806–7.PubMedGoogle Scholar
  29. 29.
    Heyman HJ, Salem MR, Klimov I. Persistent sixth cranial nerve paresis following blood patch for postdural puncture headache. Anesth Analg. 1982;61:948–9.PubMedGoogle Scholar
  30. 30.
    Szokol JW, Falleroni MJ. Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture. Reg Anesth Pain Med. 1999;24:470–2.PubMedGoogle Scholar
  31. 31.
    Béchard P, Perron G, Larochelle D, Lacroix M, Labourdette A, Dolbec P. Case report: epidural blood patch in the treatment of abducens palsy after a dural puncture. Can J Anaesth. 2007;54:146–50.PubMedGoogle Scholar
  32. 32.
    Vial F, Bouaziz H, Adam A, Buisset L, Laxenaire MC, Battaglia A. Oculomotor paralysis and spinal anesthesia (article in French). Ann Fr Anesth Reanim. 2001;20:32–5.PubMedGoogle Scholar
  33. 33.
    Arcand G, Girard F, McCormack M, Chouinard P, Boudreault D, Williams S. Bilateral sixth cranial nerve palsy after unintentional dural puncture. Can J Anaesth. 2004;51:821–3.PubMedGoogle Scholar
  34. 34.
    Dillon WP, Fishman RA. Some lessons learned about the diagnosis and treatment of spontaneous intracranial hypotension. Am J Neuroradiol. 1998;19:1001–2.PubMedGoogle Scholar
  35. 35.
    Sencakova D, Mokri B, McClelland RL. The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology. 2001;57:1921–3.PubMedGoogle Scholar
  36. 36.
    Berroir S, Loisel B, Ducros A, Boukobza M, Tzourio C, Valade D, Bousser MG. Early epidural blood patch in spontaneous intracranial hypotension. Neurology. 2004;63:1950–1.PubMedGoogle Scholar
  37. 37.
    Ferrante E, Arpino I, Citterio A, Savino A, Sterzi R. Lumbar epidural blood patch in Trendelenburg position to treat the headache by spontaneous CSF leak. Neurology. 2007;68 Suppl 1:A128–9.Google Scholar
  38. 38.
    Ferrante E, Arpino I, Citterio A, Wetzl R, Savino A. Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension. Eur J Neurol. 2010;17:715–9.PubMedGoogle Scholar
  39. 39.
    Ferrante E, Arpino I, Citterio A, Savino A. Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in the Trendelenburg position pre-medicated with acetazolamide. Clin Neurol Neurosurg. 2009;111:699–702.PubMedGoogle Scholar
  40. 40.
    Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9–160.Google Scholar
  41. 41.
    Shear T, Ahmed SU. Epidural blood patch for chronic daily headache with postural component: a case report and the review of published cases. Pain Physician. 2008;11:77–80.PubMedGoogle Scholar
  42. 42.
    Parris WC. Use of epidural blood patch in treating chronic headache: report of six cases. Can J Anaesth. 1987;34:403–6.PubMedGoogle Scholar
  43. 43.
    Katz J. Treatment of a subarachnoid-cutaneous fistula with an epidural blood patch. Anesthesiology. 1984;60:603–4.PubMedGoogle Scholar
  44. 44.
    Kumar V, Maves T, Barcellos W. Epidural blood patch for treatment of subarachnoid fistula in children. Anaesthesia. 1991;46:117–8.PubMedGoogle Scholar
  45. 45.
    Chauhan C, Francis GA, Kemeny AA. The avoidance of surgery in the treatment of subarachnoid cutaneous fistula by the use of an epidural blood patch: technical case report. Neurosurgery. 1995;36:612–4.PubMedGoogle Scholar
  46. 46.
    Velarde CA, Zuniga RE, Leon RF, Abram SE. Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device. Reg Anesth Pain Med. 2000;25:76–8.PubMedGoogle Scholar
  47. 47.
    Kowbel MA, Comfort VK. Caudal epidural blood patch for the treatment of a paediatric subarachnoid-cutaneous fistula. Can J Anaesth. 1995;42:625–7.PubMedGoogle Scholar
  48. 48.
    Doss NW, Ambrish M, Ipe J, Michael R, Gintautas J. Epidural blood patch after thoracotomy for treatment of headache caused by surgical tear of dura. Anesth Analg. 2000;91:1372–4.PubMedGoogle Scholar
  49. 49.
    Buvanendran A, Byrne RW, Kari M, Kroin JS. Occult cervical (C1-2) dural tear causing bilateral recurrent subdural hematomas and repaired with cervical epidural blood patch. J Neurosurg Spine. 2008;9:483–7.PubMedGoogle Scholar
  50. 50.
    Mino M, Narita N, Adachi M. Epidural blood patch for the treatment of intracranial hypotension due to CSF leakage after thoracic spine surgery (article in Japanese). No Shinkei Geka. 2001;29:865–9.PubMedGoogle Scholar
  51. 51.
    Elbiaadi-Aziz N, Benzon HT, Russell EJ, Mirkovic S. Cerebrospinal fluid leak treated by aspiration and epidural blood patch under computed tomography guidance. Reg Anesth Pain Med. 2001;26:363–7.PubMedGoogle Scholar
  52. 52.
    Cobb 3rd CA, French BN, Smith KA. Intrathecal morphine for pelvic and sacral pain caused by cancer. Surg Neurol. 1984;22:63–8.PubMedGoogle Scholar
  53. 53.
    Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010;105:255–63.PubMedGoogle Scholar
  54. 54.
    Ackerman WE, Colclough GW. Prophylactic epidural blood patch: the controversy continues. Anesth Analg. 1987;66:913.PubMedGoogle Scholar
  55. 55.
    Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care. 1983;11:4–15.PubMedGoogle Scholar
  56. 56.
    Kaul B, Sines D, Vallejo MC, DeRenzo JS, Waters J. A five year experience with post dural puncture headaches. Anesthesiology. 2007;107:A1762.Google Scholar
  57. 57.
    Palahniuk RJ, Cumming M. Prophylactic blood patch does not prevent post lumbar puncture headache. Can Anaesth Soc J. 1979;26:132–3.PubMedGoogle Scholar
  58. 58.
    Trivedi NS, Eddi D, Shevde K. Headache prevention following accidental dural puncture in obstetric patients. J Clin Anesth. 1993;5:42–5.PubMedGoogle Scholar
  59. 59.
    Ackerman WE, Juneja MM, Kaczorowski DM. Prophylactic epidural blood patch for the prevention of postdural puncture headache in the parturient. Anesthesiol Rev. 1990;17:45–9.Google Scholar
  60. 60.
    Colonna-Romano P, Shapiro BE. Unintentional dural puncture and prophylactic epidural blood patch in obstetrics. Anesth Analg. 1989;69:522–3.PubMedGoogle Scholar
  61. 61.
    Lowenwirt I, Cohen S, Zephyr J, Hamer R, Hronkova B, Rovner JS. Can prophylactic epidural blood patch reduce the incidence and severity of postpartum dural puncture headache in obstetrics? Anesth Analg. 1998;86:378S.Google Scholar
  62. 62.
    Scavone BM, Wong CA, Sullivan JT, Yaghmour E, Sherwani SS, McCarthy RJ. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Anesthesiology. 2004;10:1422–7.Google Scholar
  63. 63.
    Baraz R, Collis RE. The management of accidental dural puncture during labour epidural analgesia: a survey of UK practice. Anaesthesia. 2005;60:673–9.PubMedGoogle Scholar
  64. 64.
    Harrington BE, Schmitt AM. Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice. Reg Anesth Pain Med. 2009;34:430–7.PubMedGoogle Scholar
  65. 65.
    Johnson BA, Schellhas KP, Pollei SR. Epidurography and therapeutic epidural injections: technical considerations and experience with 5334 cases. Am J Neuroradiol. 1999;20:697–705.PubMedGoogle Scholar
  66. 66.
    White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine. 1980;5:78–86.PubMedGoogle Scholar
  67. 67.
    McGruder JM, Cooke JE, Conroy JM, Baker 3rd JD. Headache after lumbar puncture: review of the epidural blood patch. South Med J. 1988;81:1249–52.PubMedGoogle Scholar
  68. 68.
    Szeinfeld M, Ihmeidan IH, Moser MM, Machado R, Klose KJ, Serafini AN. Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology. 1986;64:820–2.PubMedGoogle Scholar
  69. 69.
    Colonna-Romano P, Linton P. Cervical dural puncture and lumbar extradural blood patch. Can J Anaesth. 1995;42:1143–4.PubMedGoogle Scholar
  70. 70.
    Yokota H, Yokoyama K, Noguchi H, Uchiyama Y, Iwasaki S, Sakaki T. Thoracic osteophyte causing spontaneous intracranial hypotension. Cephalalgia. 2008;28:396–8.PubMedGoogle Scholar
  71. 71.
    Hasiloglu ZI, Abuzayed B, Imal AE, Cagil E, Albayram S. Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases. Eur Spine J. 2012;21 Suppl 4:383–6.PubMedCentralGoogle Scholar
  72. 72.
    Peng PW, Farb R. Spontaneous C1-2 CSF leak treated with high cervical epidural blood patch. Can J Neurol Sci. 2008;35(1):102–5.PubMedGoogle Scholar
  73. 73.
    Paech MJ, Doherty DA, Christmas T, Wong CA, Epidural Blood Patch Trial Group. The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg. 2011;113:126–33.PubMedGoogle Scholar
  74. 74.
    Martin R, Jourdain S, Clairoux M, Tétrault JP. Duration of decubitus position after epidural blood patch. Can J Anaesth. 1994;41:23–5.PubMedGoogle Scholar
  75. 75.
    Abouleish E, Vega S, Blendinger I, Tio TO. Long-term follow-up of epidural blood patch. Anesth Analg. 1975;54:459–63.PubMedGoogle Scholar
  76. 76.
    Vercauteren MP, Hoffmann VH, Mertens E, Sermeus L, Adriaensen HA. Seven-year review of requests for epidural blood patches for headache after dural puncture: referral patterns and the effectiveness of blood patches. Eur J Anaesthesiol. 1999;16:298–303.PubMedGoogle Scholar
  77. 77.
    Ylönen P, Kokki H. Epidural blood patch for management of postdural puncture headache in adolescents. Acta Anaesthesiol Scand. 2002;46:794–8.PubMedGoogle Scholar
  78. 78.
    Williams EJ, Beaulieu P, Fawcett WJ, Jenkins JG. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth. 1999;8:105–9.PubMedGoogle Scholar
  79. 79.
    Andrews PJ, Ackerman WE, Juneja M, Cases-Cristobal V, Rigor BM. Transient bradycardia associated with extradural blood patch after inadvertent dural puncture in parturients. Br J Anaesth. 1992;69:401–3.PubMedGoogle Scholar
  80. 80.
    Woodward WM, Levy DM, Dixon AM. Exacerbation of post-dural puncture headache after epidural blood patch. Can J Anaesth. 1994;4:628–31.Google Scholar
  81. 81.
    Willner D, Weissman C, Shamir MY. Chronic back pain secondary to a calcified epidural blood patch. Anesthesiology. 2008;108:535–7.PubMedGoogle Scholar
  82. 82.
    Tekkök IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth. 1996;43:306–9.PubMedGoogle Scholar
  83. 83.
    Kalina P, Craigo P, Weingarten T. Intrathecal injection of epidural blood patch: a case report and review of the literature. Emerg Radiol. 2004;11:56–9.PubMedGoogle Scholar
  84. 84.
    Hasiloglu ZI, Albayram S, Ozer H, Olgun DC, Selcuk H, Kaynar MY. Cranial subarachnoid hemorrhage as an unusual complication of epidural blood patch. Clin Neurol Neurosurg. 2011;113:689–92.PubMedGoogle Scholar
  85. 85.
    Desai MJ, Dave AP, Martin MB. Delayed radicular pain following two large volume epidural blood patches for post-lumbar puncture headache: a case report. Pain Physician. 2010;13:257–62.PubMedGoogle Scholar
  86. 86.
    Collier CB. Blood patches may cause scarring in the epidural space: two case reports. Int J Obstet Anesth. 2011;20:347–51.PubMedGoogle Scholar
  87. 87.
    Collis RE, Harries SE. A subdural abscess and infected blood patch complicating regional analgesia for labour. Int J Obstet Anesth. 2005;14:246–51.PubMedGoogle Scholar
  88. 88.
    Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, Yatsushige H, Sugawara T. Progressive subdural hematomas after epidural blood patch for spontaneous intracranial hypotension. J Anesth. 2010;24:315–6.PubMedGoogle Scholar
  89. 89.
    Fujimaki H, Saito N, Tosaka M, Tanaka Y, Horiguchi K, Sasaki T. Cerebrospinal fluid leak demonstrated by three-dimensional computed tomographic myelography in patients with spontaneous intracranial hypotension. Surg Neurol. 2002;58:280–5.PubMedGoogle Scholar
  90. 90.
    Mikawa S, Ebina T. Spontaneous intracranial hypotension complicating subdural hematoma: unilateral oculomotor nerve palsy caused by epidural blood patch (article in Japanese). No Shinkei Geka. 2001;29:747–53.PubMedGoogle Scholar
  91. 91.
    Tom DJ, Gulevich SJ, Shapiro HM, Heaton RK, Grant I. Epidural blood patch in the HIV-positive patient. Review of clinical experience. San Diego HIV Neurobehavioral Research Center. Anesthesiology. 1992;76:943–7.PubMedGoogle Scholar
  92. 92.
    Parris WC. Post-dural puncture headache and epidural blood patch in an AIDS patient. J Clin Anesth. 1997;9:87–8.PubMedGoogle Scholar
  93. 93.
    Martin DP, Bergman BD, Berger IH. Epidural blood patch and acute varicella. Anesth Analg. 2004;99:1760–2.PubMedGoogle Scholar
  94. 94.
    Bucklin BA, Tinker JH, Smith CV. Clinical dilemma: a patient with postdural puncture headache and acute leukemia. Anesth Analg. 1999;88:166–7.PubMedGoogle Scholar
  95. 95.
    Lee LC, Sennett M, Erickson JM. Prevention and management of post-lumbar puncture headache in pediatric oncology patients. J Pediatr Oncol Nurs. 2007;24:200–7.PubMedGoogle Scholar
  96. 96.
    Ong BY, Graham CR, Ringaert KR, Cohen MM, Palahniuk RJ. Impaired epidural analgesia after dural puncture with and without subsequent blood patch. Anesth Analg. 1990;70:76–9.PubMedGoogle Scholar
  97. 97.
    Blanche R, Eisenach JC, Tuttle R, Dewan DM. Previous wet tap does not reduce success rate of labor epidural analgesia. Anesth Analg. 1994;79:291–4.PubMedGoogle Scholar
  98. 98.
    Vakharia SB, Thomas PS, Rosenbaum AE, Wasenko JJ, Fellows DG. Magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of blood patch in postdural puncture headache. Anesth Analg. 1997;84:585–90.PubMedGoogle Scholar
  99. 99.
    Gerritse BM, van Dongen RT, Crul BJ. Epidural fibrin glue injection stops persistent cerebrospinal fluid leak during long-term intrathecal catheterization. Anesth Analg. 1997;84:1140–1.PubMedGoogle Scholar
  100. 100.
    Crul BJ, Gerritse BM, van Dongen RT, Schoonderwaldt HC. Epidural fibrin glue injection stops persistent postdural puncture headache. Anesthesiology. 1999;91:576–7.PubMedGoogle Scholar
  101. 101.
    Kamada M, Fujita Y, Ishii R, Endoh S. Spontaneous intracranial hypotension successfully treated by epidural patching with fibrin glue. Headache. 2000;40:844–7.PubMedGoogle Scholar
  102. 102.
    Montana M, Tabélé C, Curti C, Terme T, Rathelot P, Gensollen S, Vanelle P. Organic glues or fibrin glues from pooled plasma: efficacy, safety and potential as scaffold delivery systems. J Pharm Pharm Sci. 2012;15:124–40.PubMedGoogle Scholar
  103. 103.
    Cesur M, Alici HA, Erdem AF, Yüksek MS. Epidural blood patch with allogeneic blood for post-dural puncture headache. Int J Obstet Anesth. 2005;14:261–2.PubMedGoogle Scholar
  104. 104.
    Trentman TL, Hoxworth JM, Kusne S, Torloni AS, Patel NP, Rosenfeld DM. Allogeneic epidural blood patch in the setting of persistent spinal headache and disseminated coccidioidomycosis. Pain Physician. 2009;12:639–43.PubMedGoogle Scholar
  105. 105.
    McKenzie A, Manson L. Allogeneic blood for epidural blood patch – not without risk. Int J Obstet Anesth. 2006;15:260.PubMedGoogle Scholar
  106. 106.
    Turner M. Epidural blood patch with allogeneic blood for post-dural puncture headache. Int J Obstet Anesth. 2006;15:261.PubMedGoogle Scholar
  107. 107.
    Clarke JM. Surgery in Jehovah’s witnesses. Br J Hosp Med. 1982;27:497–500.PubMedGoogle Scholar
  108. 108.
    Sacks DA, Koppes RH. Blood transfusion and Jehovah’s Witnesses: medical and legal issues in obstetrics and gynecology. Am J Obstet Gynecol. 1986;154:483–6.PubMedGoogle Scholar
  109. 109.
    Jagannathan N, Tetzlaff JE. Epidural blood patch in a Jehovah’s Witness patient with post-dural puncture cephalgia. Can J Anaesth. 2005;52:113.PubMedGoogle Scholar
  110. 110.
    Tanaka T, Muratani T, Kusaka Y, Minami T. Epidural blood patch for intracranial hypotension with closed system in a Jehovah’s Witness (article in Japanese). Masui. 2007;56:953–5.PubMedGoogle Scholar
  111. 111.
    Silva L de A, de Carli D, Cangiani LM, Gonçalves Filho JB, da Silva IF. Epidural blood patch in Jehovah’s Witness: two cases report. Rev Bras Anestesiol. 2003;53:633–9.
  112. 112.
    Bearb ME, Pennant JH. Epidural blood patch in a Jehovah’s Witness. Anesth Analg. 1987;66:1052.PubMedGoogle Scholar
  113. 113.
    Kanumilli V, Kaza R, Johnson C, Nowacki C. Epidural blood patch for Jehovah’s Witness patient. Anesth Analg. 1993;77:872–3.PubMedGoogle Scholar
  114. 114.
    Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295:2286–96.PubMedGoogle Scholar
  115. 115.
    Lahoria R, Allport L, Glenn D, Masters L, Shnier R, Davies M, Hersch M. Spontaneous low pressure headache – a review and illustrative patient. J Clin Neurosci. 2012;19(8):1076–9.PubMedGoogle Scholar
  116. 116.
    Couch JR, Persson J. Treatment of spontaneous intracranial hypotension with epidural blood patch: is a complex approach necessary or better than a simple one? Acta Anaesthesiol Scand. 2012;56(10):1207–9.PubMedGoogle Scholar
  117. 117.
    Cho KI, Moon HS, Jeon HJ, Park K, Kong DS. Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology. 2011;76(13):1139–44.PubMedGoogle Scholar
  118. 118.
    Chung SJ, Kim JS, Lee MC. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology. 2000;55:1321–7.PubMedGoogle Scholar
  119. 119.
    Kim SY, Hong JH. Epidural blood patches in a patient with multi-level cerebrospinal fluid leakage that was induced by spontaneous intracranial hypotension. Korean J Pain. 2010;23:46–50.PubMedCentralPubMedGoogle Scholar
  120. 120.
    Beleña JM, Nuñez M, Yuste J, Plaza-Nieto JF, Jiménez-Jiménez FJ, Serrano S. Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch. Acta Anaesthesiol Scand. 2012;56(10):1332–5.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Anesthesiology, Intensive Care, and Pain ManagementAin Shams UniversityCairoEgypt
  2. 2.Center for Pain Medicine, Western Reserve HospitalCuyahoga FallsUSA

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