A case of late orthostatic headache secondary to lumbar hidden dural fistula 20 months after epidural anesthesia

Abstract

Key Clinical MessageThe clinical recognition of CSF fistula is a clinical challenge. We report the case of a young woman, who presented with a late orthostatic headache 20 months after epidural anesthesia. She developed a lumbar dural fistula of CSF confirmed in myelography CT scanning and treated successfully with epidural blood patch.

A Novel Makeshift Method to Collect Leaking Epidural Fluid: A Case Report

“…If there is a fluid leaking out of the skin, it is generally more likely to be interstitial fluid. However, it becomes necessary to rule out CSF leak because of the associated risk of central nervous system infection [1][2][3], hematoma, intracranial hemorrhage, post-dural puncture headache, and even brain herniation. A fluid leak out of the skin may be seen immediately upon the removal of the epidural catheter or at some later time [1][2][3][4].…”

“…However, it becomes necessary to rule out CSF leak because of the associated risk of central nervous system infection [1][2][3], hematoma, intracranial hemorrhage, post-dural puncture headache, and even brain herniation. A fluid leak out of the skin may be seen immediately upon the removal of the epidural catheter or at some later time [1][2][3][4]. The biochemical composition of CSF and interstitial fluid is very different, so the biochemical analysis may prove helpful to differentiate one from another.…”