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

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a rare disorder characterized by cerebrospinal fluid loss and associated neurological effects, including coma. An epidural blood patch (EBP) is an established treatment, but procedural assessment often relies on patient feedback. In patients with impaired consciousness, an objective surrogate is needed. CASE: A 40-year-old man with a newly identified intracranial lesion developed progressive cognitive decline with subsequent imaging demonstrating SIH. Despite medical and neurosurgical interventions, his neurological status continued to deteriorate. An EBP was performed based on clinical and radiographic findings. Given his comatose state and inability to provide verbal feedback, electromyography (EMG) with fluoroscopic guidance was used to assess procedural safety and efficacy. Following EMG-assisted EBP, the patient demonstrated progressive neurological improvement. CONCLUSIONS: This case highlights the utility of electromyography as an innovative adjunct in performing epidural blood patch in patients with compromised consciousness, offering an effective approach for managing severe spontaneous intracranial hypotension.