Abstract
Dear Sir We have read the comments of Dr Ferrante (1) about our case of spontaneous intracranial hypotension (SIH) (2). Our patients did not undergo epidural blood patches (EBP) under radiographic guidance nor receive an imaging examination post-EBP to make sure the injected blood was in the epidural space. Indeed, we have treated more than 50 patients with SIH including another comatose patient (3). Our anesthesiologists are skillful in performing the EBP procedure. Therefore, we believe the possibility of incorrect injection was very low. We reported this unique patient because he had a very rapid deterioration process. It took about 7–8 hours from wakefulness to deep coma with pupil dilatation. It is possible that uncal herniation with Duret hemorrhage had developed during or before the EBP procedure and the clinical course was irreversible at that time. Therefore, we advocate that although rarely seen, brain descent in patients with SIH could develop very acutely and rapidly and cause severe disability. We do not know if earlier intervention could have stopped this unusual complication.