High Spinal Anesthesia in a Patient Recently Submitted to an Epidural Blood Patch: A Case Report

Main Article Content

Marcos Victor Silveira Crisanto
Katharina Lanza Japolini
https://orcid.org/0000-0001-7488-6906
Camila Gomes Dall'Aqua
Marina Ayres Delgado
https://orcid.org/0000-0001-6428-1516

Abstract


Spontaneous intracranial hypotension (SIH) is a rare condition caused by cerebrospinal fluid (CSF) leakage, leading to orthostatic headache and associated symptoms such as nausea, vertigo, and visual disturbances. Epidural blood patch (EBP) is the first-line therapy for persistent symptoms. Neuraxial anesthesia after recent EBP poses unique challenges due to morphological changes in the epidural space. These changes, primarily caused by clot formation and subsequent fibrosis, can result in unpredictable epidural spread or excessive cephalad migration during spinal anesthesia. We report the case of a 30-year-old primigravida with SIH who underwent two EBPs during pregnancy and subsequently developed a high spinal block during elective cesarean delivery under spinal anesthesia. The patient experienced hypotension and bradycardia and sensitive blockade at C6, which were managed successfully, and both mother and newborn had an uneventful outcome. This case highlights the potential for erratic neuraxial block following recent EBP and provides a detailed discussion of the underlying mechanisms and management strategies. It underscores the importance of careful review of anesthetic history, individualized technique, and dosing adjustments. Evidence on the optimal timing and safety of neuraxial anesthesia after EBP is limited, and further research is needed to guide clinical decision-making in this setting.


Article Details

How to Cite
Crisanto, M. V. S., Japolini, K. L., Dall’Aqua, C. G., & Delgado, M. A. (2025). High Spinal Anesthesia in a Patient Recently Submitted to an Epidural Blood Patch: A Case Report. Brazilian Journal of Case Reports, 6(1), bjcr122. https://doi.org/10.52600/2763-583X.bjcr.2026.6.1.bjcr122
Section
Clinical Case Reports
Author Biographies

Marcos Victor Silveira Crisanto, Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais

Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Katharina Lanza Japolini, Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais

Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Camila Gomes Dall'Aqua, Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais

Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Marina Ayres Delgado, Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais

Division of Anesthesiology, Department of Surgery, Hospital das clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

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