Treatment experience for cerebro-spinal fluid leak associated with idiopathic thrombocytopenic purpura

• Published in: Journal of Japan Society of Pain Clinicians Vol. 30; no. 11; pp. 256 - 260
• Main Authors: YAMAMURA, Yuji, WATANABE, Keisuke, FUJIWARA, Aki, KIMOTO, Katsuhiro, YOSHIMURA, Kie, KAWAGUCHI, Masahiko
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Pain Clinicians 25.11.2023
• Subjects: cerebro-spinal fluid leak; epidural blood patch; idiopathic thrombocytopenic purpura; intraoperative cone-beam CT
• ISSN: 1340-4903; 1884-1791
• DOI: 10.11321/jjspc.23-0004

A 42-year-old male with idiopathic thrombocytopenic purpura (ITP) had been consulted a neurosurgeon for an orthostatic headache and had undergone a drainage against chronic subdural hematoma. Idiopathic cerebro-spinal fluid leak was suspected, however, there were some possibilities of due to minor trauma. Although a CT myelography was needed to make a definitive diagnosis, we diagnosed with cerebro-spinal fluid leak by MR myelography to avoid intraspinal bleeding. At the same time, we consulted the hematologist and started the platelet recovery therapy. After injecting autologous blood and iohexol, we examined the spread of injected blood using intraoperative cone-beam CT to determine whether additional epidural blood patch (EBP) would be required. No additional EBP was needed. Consequently, he made a full recovery without any complications. A case of cerebrospinal fluid leakage associated with idiopathic thrombocytopenic purpura was a high-risk patient, but fortunately was treated without complications. Intraoperative cone-beam CT is useful for examining the spread of injected blood.