Resolution of diplopia with late treatment of post-dural puncture headache and intracranial hypotension

Abstract

America. We agree with Peng and his colleagues that it is vital to gather this basic information, in order to develop effective, chronic pain services for children in the future.

Ocular Motor Palsy After Spinal Puncture

“…Of the 114 reviewed cases, 19 epidural blood patches (EBPs) were used: 2 before diplopia onset, 9,24 7 during the first 24 hours after diplopia onset, 8,17,[25][26][27][28][29] and 8 EBPs 24 hours after diplopia onset. 2,27,[30][31][32][33][34][35] The other cases were not notified in time to undertake EBP. 2,36 Finally, 9.63% of the patients required an eye patch, and 5.25% needed a prism glass.…”

“…However, diplopia lasted more than or equal to 6 months in 19 patients (16.66% of cases). The palsy was permanent in 13 patients (11.40 %), but only 2 patients required corrective surgery for extraocular muscles, 17,33 which was resorted to if diplopia persisted for more than 1 year. In both cases, EBP was performed between 24 and 48 hours.…”

“…In both cases, EBP was performed between 24 and 48 hours. 17,33 DISCUSSION Extraocular muscle palsy is not a common disorder and is caused by a variety of etiologies: neoplasia, trauma, vascular lesions, multiple sclerosis, myasthenia gravis, thyroid disease, diabetes, myositis, intracranial tumor, arteriovenous malformation, and hematoma. [38][39][40] Therefore, cranial nerve palsy after spinal puncture must be considered a diagnosis of exclusion by ruling out these pathologies through neuroimaging.…”

“…24,27,30 Epidural blood patch is most effective for treating PDPH (93% effectiveness), but it has not been demonstrated to be an efficacious treatment for EOMP. 8,25,27,28,30,33,36,50 In the 114 cases in our review, 2 patients underwent prophylactic EBP during the first 24 to 48 hours. Nevertheless, it did not restore the function of cranial nerves, not even when headaches were fully resolved, and both cases required surgery.…”

“…Nevertheless, it did not restore the function of cranial nerves, not even when headaches were fully resolved, and both cases required surgery. 17,33 An eye patch can be a palliative measure to avoid double vision and sickness in patients. Another conservative measure is to minimize patient discomfort by applying prism glasses for minor deviations.…”