Novel Use of Electromyography Guidance for Epidural Blood Patch Injection in a Comatose Patient due to Severe Spontaneous Intracranial Hypotension - A case report -

Spontaneous intracranial hypotension (SIH) is a relatively rare condition characterized by abnormally low cerebrospinal fluid pressure, leading to various neurological effects. Patient presentation ranges from nonspecific symptoms, such as postural headache, nausea, and vomiting, to severe symptoms, such as coma. In this report, we present the case of severe SIH in a comatose patient that was successfully managed using an epidural blood patch guided by electromyography (EMG). Owing to the patient’s altered neurological status, conventional feedback mechanisms were unavailable. However, to ensure procedural accuracy and safety, the patch treatment was conducted using EMG monitoring, combined with fluoroscopic guidance, which provided real-time feedback. Following the EMG-assisted epidural blood patch, the patient showed progressive neurological improvement. Thus, in patients with compromised consciousness, EMG can guide the performance of epidural blood patch. EMG-guided epidural blood patch is an effective approach for managing severe SIH.