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

Abstract

IntroductionCervical epidural corticosteroid injections are frequently used for the treatment of subacute cervicobrachial pain. This therapy is considered safe, with the vast majority of the complications being minor and transient.Case ReportWe present a case of a woman in her fifties who suffered from cervicobrachialgia and received 2 cervical epidural corticosteroid infiltrations. On day 3 after the second infiltration, a new headache appeared and on day 16 a bilateral subdural hematoma was visualized on CT scan. Complete resorption of the hematoma was seen on day 25 without surgical intervention.DiscussionUp until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published. But several cases of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have been reported. Physicians should be aware of this potentially dramatic complication since post‐dural puncture headache after any type of procedure can evolve into a subdural hematoma. Clinical differentiation between the two can be difficult; post‐dural puncture headache is characterized by relief of symptoms in the supine position and photophobia/phonophobia. A subdural hematoma should be considered if the headache changes in character, does not respond to treatment, or there are neurological signs such as nausea/vomiting and blurred vision. Immediate medical imaging should then be performed.

Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma

“…In ad- dition, HT2W-MRM is free from concerns on rare but serious complications. Intrathecal contrast injection could elicit seizures in both patients with and without epilepsy 20) and those with intracranial hypotension or SDH 10,21) , and eliminating additional morbidity and mortality at the diagnosis stage is worth trying. Radiation is another factor to be concerned about, and HT2W-MRM can be performed with fewer personnel due to the ease of procedure.…”

“…Studies have used invasive modalities to identify CSF leakage sites, such as radionuclide cisternography, computed tomography (CT) myelography, and magnetic resonance myelography (MRM) with contrast agent 3,9,30) . A universal step in those invasive modalities is lumbar puncture, which could pose a specific risk of CSF leakage through the puncture site, procedure-related infection, and concomitant complications, including SDH 10,21) . In addition, complications from radiation or intrathecal contrast injection should be considered 18,20) .…”

2. Cervical radicular pain

“…Hence, both closed claims analyses and guidelines recommend the avoidance of deep sedation, which may prevent patient feedback during spinal cord violation 100 . An intracranial subdural hematoma after a cervical epidural steroid injection is also a potential complication 101,102 . Interlaminar CESI should always be performed under image guidance, preferably using fluoroscopy.…”

“…100 An intracranial subdural hematoma after a cervical epidural steroid injection is also a potential complication. 101,102 Interlaminar CESI should always be performed under image guidance, preferably using fluoroscopy.…”

Resolución espontánea de hematoma subdural secundario a anestesia raquídea: reporte de caso

“…La punción lumbar (PL) es una técnica empleada frecuentemente en la práctica médica con fines diagnósticos o terapéuticos, especialmente en la raquianestesia, las cual han documentado efectos adversos como cefalea, lumbalgias, lesiones radiculares, infecciones, pero con relación al hematoma subdural (HSD) es una complicación infrecuente, se estima que la prevalencia de dicha entidad es de 1/500.000-1/1.000.000 1 .…”