Epidural Blood Patch Therapy for Chronic
Shinichi Ishikawa, MD*†
Masataka Yokoyama, MD†
Satoshi Mizobuchi, MD†
Hidenori Hashimoto, MD*
Eiji Moriyama, MD‡
Kiyoshi Morita, MD†
BACKGROUND: Despite the absence of objective neurological deficits, patients with
chronic whiplash-associated disorder (WAD) complain of symptoms such as
headache, dizziness, and nausea. These symptoms are also often experienced by
patients with cerebrospinal fluid (CSF) leak. It was recently reported that radio-
isotope (RI) cisternography is useful in the diagnosis of intracranial hypotension
due to CSF leak. We investigated the relation between chronic WAD and CSF leak
by RI cisternography and evaluated whether epidural blood patch (EBP) adminis-
tration is effective in the treatment of chronic WAD.
METHODS: We studied 66 patients with chronic WAD with symptoms lasting longer
than 3 mo. All patients underwent RI cisternography to determine the presence of
CSF leak. In patients in whom CSF leak was identified, EBP was administered.
Symptoms were assessed before, 1 wk after, and 6 mo after EBP. Work status was
also assessed and follow-up RI cisternography was performed.
RESULTS: Of the 66 patients, 37 showed CSF leak, and 36 of these patients received
EBP 2.2 0.7 times. The mean duration of symptoms was 33 mo. One week after
EBP, the percentage of patients with symptoms was decreased significantly
compared with that before EBP; headache: 100% vs 17%, respectively, memory loss:
94% vs 28%, dizziness: 83% vs 47%, visual impairment: 81% vs 25%, nausea: 78%
vs 42% (P 0.01). These effects were also observed at the 6 month follow-up
examination (P 0.01). Work status was also significantly improved at follow-up.
CONCLUSIONS: We conclude that CSF leak should be considered in some cases of
chronic WAD and that EBP is an effective therapy for chronic WAD.
(Anesth Analg 2007;105:809–14)
Although whiplash-associated disorder (WAD) is
usually self-limited, with a good prognosis (1), some
patients suffer persistent and i