Treatment of Idiopathic Intracranial Hypotension: Cervicothoracic and Lumbar Blood Patch and Peroral Steroid Treatment


  • Jan Hannerz MD, PhD,

  • Gunnar Dahlgren MD, PhD,

  • Lars Irestedt MD, PhD,

  • Björn Meyerson MD, PhD,

  • Kaj Ericson MD, PhD

  • From the Department of Neurology, Karolinska Hospital, Stockholm, Sweden (Dr. Hannerz); Department of Anaesthesiology, Karolinska Hospital, Stockholm, Sweden (Drs. Dahlgren and Irestedt); Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden (Dr. Meyerson); and Department of Neuroradiology, Karolinska Hospital, Stockholm, Sweden (Dr. Ericson)

Address all correspondence to Dr. Jan Hannerz, Department of Neurology, Karolinska Hospital, Stockholm SE 17176, Sweden.


Methods.—Twelve consecutive patients with clinical symptoms and testing results compatible with a diagnosis of idiopathic intracranial hypotension (IIH), but no identifiable site of cerebrospinal fluid (CSF) leakage, were treated with a cervicothoracic or lumbar epidural “blood patch” (EBP) or orally administered steroids.

Results.—Prompt and complete relief from headache persisting for at least 4 months was attained in 3 of 4 treatments with cervicothoracic EBP, 2 of 15 with lumbar EBP, and 4 of 8 with steroids.

Conclusion.—These results suggest that in patients who presumably suffer from IIH and yet have no identifiable site of CSF leakage, the presumed leakage more often occurs at the cervicothoracic level than the lumbar. In addition, our experience suggests that some IIH patients may be treated effectively with oral steroids and a trial of such therapy may be considered as an alternative to EBP.