Resolution of Spontaneous CSF Leak with Platelet Lysate Epidural Injection - A Case Report

Spontaneous cerebrospinal fluid leakage is a rare event consisting of cerebrospinal fluid escaping through a dura mater defect without an identifiable cause. Cases commonly present with orthostatic headaches, however atypical presentations can delay diagnosis and complicate management. This case report describes a 66-year-old male who experienced left sided headaches, dizziness, decreased depth perception and visual changes beginning in 2017. Imaging demonstrated subdural hygromas, diffuse dural enhancement, brain sagging and intracranial hypotension without definitive localization of the leak. The patient was referred to neurology and neurosurgery specialists who recommended an epidural blood patch. Out of concern regarding the inflammatory properties of whole blood, along with the potential benefit of concentrated growth factors, an epidural injection using platelet lysate derived via apheresis was performed. The lysate was prepared by centrifugation, freezing, reconstitution in sterile water, and the addition of platelet-poor plasma, yielding a sixfold concentration of growth factors. The solution was injected in the epidural space of the lumbar spine under fluoroscopic guidance and use of Omnipaque dye. The patient experienced immediate relief of postural headaches which were consistent at a one month follow up without adverse events. This case report illustrates the potential role of platelet lysate in treating spontaneous cerebrospinal fluid leaks, particularly in cases with atypical presentation. Further studies are needed to determine the safety and efficacy in broader patient populations.