Epidural Blood Patch is the most important treatment for spontaneous intracranial hypotension–type headaches. The patient is treated with 20 cc of their own blood drawn from an arm vein. This procedure is applied to stop cerebrospinal fluid leaks. It is generally preferred for headaches that develop after dural puncture. These headaches worsen in the upright position. By restoring cerebrospinal fluid pressure, the patient breathes easily again and cerebral blood flow improves. Thus, the epidural blood patch provides a solution for spinal headache.
| Medical Name | Epidural Blood Patch |
| Affected Areas | Spinal canal (site of cerebrospinal fluid) |
| Causes | Cerebrospinal fluid (CSF) leak; often after lumbar puncture or epidural anesthesia |
| Symptoms | Severe headache (worsens on standing), nausea, vomiting, neck stiffness, hearing changes |
| Diagnosis | Clinical evaluation (postural headache after lumbar puncture), MRI (can show CSF leak) |
| Treatment | Epidural blood patch: autologous blood injected into the epidural space to seal the leak and restore pressure |
| Possible Complications | Infection, nerve injury, pain, bleeding, headache recurrence, radicular symptoms |
| Prevention | Careful technique during lumbar puncture/epidural, adequate hydration |
| Recovery Time | Headache usually improves within hours to days after the procedure |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is an Epidural Blood Patch?
An epidural blood patch is used to stop cerebrospinal fluid leaks. These leaks cause severe head and neck pain when upright—especially upon standing—because CSF pressure drops. Cerebral blood flow increases, triggering a characteristic post‑dural puncture headache that worsens when upright and improves when supine. During the patch, a small amount of the patient’s blood is injected into the epidural space to create a physical barrier at the leak site. It is an effective treatment for dural puncture–related headaches.
Key risk factors include:
- Needle size
- Age under 60
- Female sex
Headaches typically begin 24–48 hours later and have these features:
- Frontal–occipital localization
- “Clamping” pain quality
- Cranial symptoms like hearing loss and blurred vision
Conservative measures (bed rest, analgesics, NSAIDs, hydration) provide only temporary relief. An epidural blood patch offers definitive relief with ~85 % success, rising to 90 % with repeat patches. Rarely, failed cases may require embolization or surgery.
When Is It Done and When Is It Contraindicated?
An epidural blood patch is critical when conservative measures (rest, medications) fail to relieve post‑dural puncture headache. However, it should not be performed if the patient:
- Is on anticoagulation
- Has infection at the injection site
- Refuses or cannot cooperate with the procedure
Patient–physician collaboration is essential for success.
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Preparation for an Epidural Blood Patch
Preparation involves thorough patient education and informed consent. The patient is positioned—usually lateral decubitus or sitting (though sitting may worsen symptoms). Sterile technique is critical. Equipment includes:
- Standard epidural kit
- Sterile drapes and supplies
After confirming epidural needle placement, 20 mL of autologous blood is slowly injected into the epidural space to seal the leak.
How Is the Epidural Blood Patch Performed?
The procedure follows these steps:
- Identify the epidural space using loss‑of‑resistance (saline or air). In complex cases, C‑arm fluoroscopy or ultrasound may be used.
- Draw ~20 mL of the patient’s blood.
- Inject the blood over 30–60 seconds into the epidural space.
Patients may feel discomfort or cramp-like pain. Even smaller volumes can be effective; studies show success with minimal autologous blood.
What Are the Complications?
About 10 % of patches fail. Additional dural tears during the procedure can worsen the headache. Common issues include:
- Back pain (mild to moderate, usually self‑limited)
- Injection‑site infection signs:
- Fever
- Fatigue
- Redness
- Purulence
Injected blood may predispose to infection, requiring urgent evaluation and treatment. Close monitoring of symptoms is crucial.
Why Is the Epidural Blood Patch Important?
An epidural blood patch effectively relieves post‑dural puncture headaches by normalizing CSF pressure. It is ideal when conservative treatments fail, especially in:
- New mothers
- Active young patients
- Cases unrelieved by rest
This minimally invasive procedure greatly improves daily functioning and quality of life. Using the patient’s own blood minimizes allergic or foreign‑body reactions.
Frequently Asked Questions
- Back pain (35 % incidence)
- Neck pain
- Facial nerve palsy
- Lumbo‑vertebral syndrome
- Rarely: infection, bleeding, nerve injury, acute neurological decline
The failure rate is ~7 %, and serious complications are uncommon.
- Rest in bed for 1–2 hours (some recommend 4–6 hours).
- Avoid driving, heavy lifting, and strenuous exercise for 24 hours.
- After 24 hours, bathing is allowed; avoid tubs, pools, or hot tubs for 3 days.
- Apply cold compresses (10–20 minutes every 1–2 hours) for injection‑site discomfort.
- Seek immediate care for severe back/leg pain, numbness, urinary retention, fever, or signs of infection.
Adherence accelerates recovery and reduces complications.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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