01 August 2026
: Case report 
Continuous Epidural Infusion of Hydroxyethyl Starch for Spontaneous Intracranial Hypotension: A Retrospective Case Series
Challenging differential diagnosis, Rare disease
Xiao-Yan Zhang
ABEF 1,2,3, Qiu-Li Zhang CEF 1,2,3, Ying Liu B 1,2,3, Li-Jie Zhu B 1,2,3, Ying-Zhi Li B 1,2,3, Xi-Ying Ye F 4, Zhong-Jun Zhang ACD 4*, Yao-Xian Zhang ACD 1,2,3
DOI: 10.12659/AJCR.953129
Am J Case Rep 2026; 27:e953129
Table 1 Clinical characteristics and disease progression.
| Case | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|
| Sex/age | F/36 years | M/45 years | F/35 years | M/35 years |
| Description of orthostatic headache | A sharp or stabbing pain in the parietal-occipital region | Severe, bilateral frontotemporal headache | Generalized head pain with a sensation of swelling | Occipital headache triggered by air travel |
| Associated symptoms | Nausea | Dizziness and cerebral distension | Dizziness, tinnitus, and non-jet vomiting | Nausea and vomiting |
| History of major trauma and lumbar puncture | None | None | None | None |
| Significant prior medical history | None | Asthma | None | None |
| Neurological examination | Normal | Normal | Normal | Normal |
| Treatment approaches | Conservative treatmentEBPSDH evacuationEpidural HES infusion (administered on hospital days 25 to 30) | Pharmacological therapySDH evacuationEpidural hematoma evacuationEpidural HES infusion (administered on hospital days 5 to 12) | EBPEpidural HES infusion (administered on hospital days 3 to 8) | Conservative treatmentEpidural HES infusion (administered on hospital days 9 to 12) |
| Headache status when sitting | None (hospital day 28) | None (hospital day 10) | None (hospital day 7) | None (hospital day 16) |
| Headache status when walking slowly | None (hospital day 29) | None (hospital day 11) | None (hospital day 8) | Slight headache (hospital day 17) |
| Headache status at discharge | None (hospital day 43) | None (hospital day 19) | None (hospital day 14) | Slight headache (hospital day 17) |
| Telephone follow-up | No headache attacks at months 6, 12, and 48 after discharge | No headache attacks at months 6, 12, and 29 after discharge | No headache attacks at months 6, 12, and 48 after discharge | No headache attacks at months 6, 12, and 47 after discharge |
| Abbreviations: EBP, epidural blood patching; SDH, subdural hematoma; HES, hydroxyethyl starch; F, female; M, male. | ||||