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Spontaneous intracranial hypotension following epidural anesthesia: a case report
Author(s) -
An X.,
Wu S.,
He F.,
Li C.,
Fang X.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12707
Subject(s) - medicine , epidural blood patch , anesthesia , myelography , surgery , epidural space , intracranial hypotension , post dural puncture headache , orthostatic vital signs , cerebrospinal fluid , magnetic resonance imaging , complication , blood pressure , spinal cord , spinal anesthesia , radiology , pathology , psychiatry
We report a case of refractory spontaneous intracranial hypotension ( SIH ) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post‐dural puncture headache ( PDPH ). A 56‐year‐old man received a successful appendectomy under epidural anesthesia performed at a T11–T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a PDPH was diagnosed. However, the patient did not respond well to conservative treatment. Three months later, the first epidural blood patch was performed at the L3–L4 level, however, the patient still had an orthostatic headache. Five days later, spine magnetic resonance imaging showed multiple meningeal diverticulum in the cervicothoracic junction, and computerized tomography myelography demonstrated a C5–C6 spinal dural tear suggesting cerebrospinal fluid leaks. Finally, the patient was diagnosed as SIH and received a second epidural blood patch at the T2–T3 level and responded with improvements in symptomatology. The patient was then discharged, and at a 2‐year follow‐up, he had fully recovered except for some remaining neck stiffness. This case illustrates that SIH was misdiagnosed as PDPH because of the common clinical symptoms and potentially confounding events (epidural/spinal anesthesia and assumption that it was a case of PDPH ). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of SIH , a timely epidural blood patch should be considered as soon as the diagnosis is established.