Who to Test for CSF Hypovolemia? Refining Patient Characteristics

Findings from new research conducted at Mayo Clinic may help to better define the conditions warranting invasive diagnostic testing of patients suffering from cerebrospinal fluid (CSF) hypovolemia. CSF hypovolemia is a condition in which a spontaneous leak from the spine depletes cerebrospinal fluid resulting in debilitating headache that intensifies when the patient is upright and moderates when lying down. The condition is treated with epidural blood patches, in which blood removed from the sufferer is injected into the spinal epidural space to seal the leak. The procedure is more effective when delivered directly to the location of the leak, but determination of the site involves invasive and expensive diagnostic testing. In the present study, researchers attempted to identify characteristics of CSF hypovolemia sufferers who are best indicated for such testing.

Findings from the study conclude that patients whose spinal MRI is floridly abnormal, evidences spinal epidural fluid, and/or shows severe brain sag angles are better candidates for dedicated diagnostic testing to pinpoint the location of the leak site and target the administration of the epidural blood patch. Patients who do not demonstrate these imaging features may be best served by initial administration of non-site directed epidural blood patch, and spared unnecessary and expensive testing. Findings from the study "Epidural Blood Patch (EBP) Efficacy Clinical Predictors in Spontaneous Cerebrospinal Fluid (CSF) Hypovolemia Patients" will be presented later this month at the 16th Annual Pain Medicine Meeting.

Read about the study findings and recommendations.