Case report: delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy
Anjana Kundu1, Yuko Sano, Paul S Pagel
1Department of Anesthesiology and Pain Medicine, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington 98105, USA. anjana.kundu@seattlechildrens.org
Purpose:
To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy.
Clinical Features:
A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontal-retroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment.
Conclusion:
This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.
