Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

Abstract

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

Post‐Dural Puncture Headache Evolving to a Subdural Hematoma: A Case Report

“…In other cases, the first symptoms matched PDPH and were treated accordingly. The headache disappeared but returned in 3 days to several weeks after the puncture, 9,11 just like in the earlier reported cervical case 5 . In one case, the only symptom was diplopia, which started 10 days after the spinal anesthesia.…”

“…Up until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published 5 . In that reported case, the patient revisited the clinic 5 days after the injection with a mild headache that worsened in the upright position.…”

“…As already mentioned, several different treatment options have been described: observation, blood patch, burr hole drainage, craniectomy, or a combination 5–16 . The choice should be based on the patients’ neurological status and the size of the hematoma.…”

“…We present a case of a seemingly normal procedure that evolved into a major complication: a subdural hematoma. To our knowledge, there has been only 1 similar reported case 5 . Pain therapists should be aware of this possible complication, the difficult differential diagnosis with post‐dural puncture headache (PDPH), and the possible evolution of PDPH into a subdural hematoma.…”

Single Burr Hole and Drainage in Chronic Subdural Hematoma: Outcome in Consecutive 333 Cases

“…The factors that increase the risk of CSDH are chronic alcoholism, epilepsy, coagulopathy, arachnoid cysts (age <40 years), anticoagulant therapy (including aspirin), cardiovascular disease (eg, hypertension, arteriosclerosis), thrombocytopenia, spinal anesthesia, cerebrospinal shunt procedures, severe dehydration and Diabetes mellitus. 19,11,18,34 Bilateral Mode of injury fall injury 0 85…”