Evidence map›Paper›PMID 38820488›Full record

ArticleNeurology2024

Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria.

Ian Carroll, Lichy Han, Niushen Zhang, Robert P Cowan, Bryan Lanzman, Syed Hashmi, Meredith J Barad, Addie Peretz, Leon Moskatel, Oyindamola Ogunlaja and 6 more

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Article in Neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Review
  2. Idiopathic CSF dynamic disturbances causing headache: a narrative review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Review
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Ian CarrollFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0002-4777-4834
Lichy HanFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Niushen ZhangFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Robert P CowanFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0002-6868-0108
Bryan LanzmanFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Syed HashmiFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Meredith J BaradFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0002-3182-7030
Addie PeretzFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Leon MoskatelFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0002-8596-9130
Oyindamola OgunlajaFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Jennifer M HahFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0002-9739-3968
Nada HindiyehFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Carol BarchFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Selene BozkurtFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Tina Hernandez-BoussardFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.
Andrew L CallenFrom the Department of Anesthesiology, Perioperative and Pain Medicine (I.C., L.H., M.J.B., J.M.H.), Stanford Headache Clinic (I.C.), Department of Neurology (N.Z., M.J.B., A.P., L.M., O.O., C.B.), Departments of Neurology and Neurosciences and (by courtesy) Anesthesia (R.P.C.), and Department of Radiology (B.L., S.H.), Stanford University, Palo Alto, CA; Headache Neurology (N.H.), Metrodora Institute, West Valley City, UT; Department of Biomedical Informatics (S.B.), Emory University, Atlanta, GA; Department of Medicine (Biomedical Informatics) (T.H.-B.), Stanford University, Palo Alto, CA; and Department of Radiology (A.L.C.), University of Colorado Anschutz Medical Campus, Aurora.ORCID 0000-0003-2315-7767

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesSpinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy.

methodsWe conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018.

resultsThe mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; DISCUSSION: Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.

Indexed as

Blood Patch, EpiduralCerebrospinal Fluid LeakIntracranial HypotensionAdultCase-Control StudiesCohort StudiesFemaleHumansMaleMiddle AgedPatient Reported Outcome MeasuresProspective StudiesTreatment Outcome

Identifiers

PMID38820488
PMCPMC11244740

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