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Unusual presentation of postdural puncture headache requiring repeat epidural blood patch in a 4-year-old child

Bruno C R Borges1, Gail Wong, Lisa Isaac

  • 1Department of Anesthesia, McMaster Children's Hospital/McMaster University, Hamilton, Canada.

Paediatric Anaesthesia
|December 31, 2013
PubMed

Insights

A 4-year-old child needed two epidural blood patches (EBPs) for a postdural puncture headache (PDPH) after a spinal drain. A second EBP, with a larger blood volume, successfully resolved the headache symptoms.

Area of Science:

  • Pediatric Anesthesiology
  • Neurosurgery
  • Neurology

Background:

  • Postdural puncture headache (PDPH) can occur after procedures involving the dura mater, such as lumbar cerebrospinal fluid (CSF) drainage.
  • Delayed onset PDPH presents a diagnostic and therapeutic challenge, particularly in pediatric patients.
  • Epidural blood patching (EBP) is a common treatment for PDPH, but optimal volume and efficacy in children are not well-established.

Observation:

  • A 4-year-old child developed delayed onset PDPH following the removal of a lumbar CSF drain.
  • The initial epidural blood patch (EBP) using 0.41 ml·kg(-1) of blood was ineffective in alleviating the headache.
  • A second EBP, administered two days later with a larger volume of 0.76 ml·kg(-1) of blood, resulted in complete symptom resolution.

Findings:

  • The volume of blood required for effective epidural blood patching in pediatric patients with symptomatic CSF leaks may be higher than initially administered.
  • A single epidural blood patch may not always be sufficient to treat postdural puncture headache in children.
  • Repeat epidural blood patching with an increased volume can be successful in resolving persistent PDPH.

Implications:

  • This case highlights the potential need for larger blood volumes in repeat epidural blood patches for pediatric PDPH.
  • The findings suggest that current guidelines for EBP volume in children may require re-evaluation.
  • Further research is warranted to determine the optimal volume of blood for effective EBP in pediatric patients experiencing CSF leaks and PDPH.

Keywords:
anesthesiablood patchepiduralpediatricspostdural puncture headachepostoperative complications

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