Repeat epidural blood patch at the level of unintentional dural puncture and its neurologic complications: a case report

Abstract

Background: Autologous epidural blood patch (AEBP) is effective for post-dural-puncture headache (PDPH). In some cases, repeat procedures are required for complete cure. In rare instances, severe adverse effects can occur. We present a case of neurologically complicated AEBPs, one of which was performed at the interspace of unintentional dural puncture (UDP). Case presentation: A 40-year-old primigravida sustained UDP at the L2-3 interspace during combined spinalepidural anesthesia for a scheduled cesarean section. She developed PDPH and underwent a single AEBP at L3-4. The PDPH recurred and she required another AEBP at L2-3, after which she reported radicular pains. A diagnosis of subdural hematoma and adhesive arachnoiditis was made. Her symptoms partially resolved in the following months. Conclusion: It may be prudent to reconsider the use of repeated AEBP and to avoid the interspace of UDP. A thorough evaluation is warranted to exclude treatable lesions when adverse effects occur.

Symptomatic Intrathecal Hematoma following an Epidural Blood Patch for an Obstetric Patient with Postdural Puncture Headache: A Case Report and Synthesis of the Literature

“…Case Reports in Anesthesiology Case Reports in Anesthesiology intrathecal space [2]. Case reports that mention the interspace level of blood injection also support this possibility [11,12]. Moving forward, using fluoroscopic guidance to confirm needle-tip position and the spread of injected blood during EBP placement may be useful and feasible in large academic centers such as ours.…”

Arachnoiditis, a complication of epidural blood patch for the treatment of low‐pressure headache: A case report and systematic review

“…Four cases described peri-procedural back pain or pressure, [14][15][16][17] whereas others mentioned lower extremity paresthesia 18 and radicular pain. 14 The current case is unique in describing peri-procedural transient loss of lower extremity motor function.…”

“…The onset of progressive symptoms in the post-procedure period ranged from hours to months. These symptoms were inclusive of leg or radicular pain, [14][15][16][17]19 decreased lower extremity reflexes, 17,19 worsening postural headache, 15,18,20 difficulty with standing and ambulation, and even loss of pain and temperature sensation. 16 As was the case in our report, meningitis was also suspected in two cases previously reported 15,20 with the onset of fever and nuchal rigidity warranting CSF analysis.…”

“…However, workups were largely negative for infectious processes and opening pressures were not reported. Evidence of residual subdural 14,17 and intradural 15,16 blood on imaging was common. All cases that pursued imaging also noted atypical "clumping" [14][15][16][17][18] or "kinking" 19 of nerve roots.…”

Intranasale Lidocainvernebelung als neue und nichtinvasive Therapieoption des Postpunktionskopfschmerzes

“…einem Drittel der untersuchten Fälle, während eine zumindest teilweise Besserung in 50-80 % erzielt wird [10]. Damit wird der EBP wei- [11,12]. Als potenzielles Alternativverfahren zum EBP wird die transnasale Blockade des Ganglion sphenopalatinum diskutiert [13,14], welche bereits bei verschiedenen Formen des Kopfschmerzes eingesetzt wird [15] Intranasal lidocaine atomization as novel and noninvasive treatment option for postdural puncture headache.…”