ostdural puncture headache (PDPH) is a wellrecognized complication after spinal anesthesia P (1). When conservative treatment or epidural blood patch (EBP) fail, alternative causes of the headache need to be reconsidered. We present a previously unreported association of recurrent PDPH with a Chiari I malformation. Case ReportA 31-yr-old woman (gravida 1, para 0), with an unremarkable medical history, received analgesia for labor via a lumbar epidural catheter. Subsequently, when she required cesarean section for failure of the labor to progress, satisfactory lumbar epidural anesthesia could not be established. Good surgical anesthesia was provided by subarachnoid block, although spinal needle placement proved technically difficult and required several attempts before successful dural puncture with a 22-gauge needle. The surgery and immediate postoperative period were uneventful. Although she reported a mild positional headache, her surgeon discharged her on the third postoperative day. However, over the following several days, the patient's headache became progressively more severe. The headache was associated with mild neck pain, which worsened when the patient was sitting or standing. Moderate relief was obtained by caffeine ingestion. On the sixth postoperative day, although afebrile, she developed hearing changes (echoing), visual disturbances (blurring and color distortion), and nausea. The diagnosis of PDPH was made. An EBP using 15 mL of autologous blood was administered, with marked improvement of all symptoms.The patient had a recurrence of the headache 4 days
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