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[Chronic post-dural headache secondary to meningitis]
Andreas Ravn1, Louise Feldborg Lyckhage, Rigmor Høland Jensen
1ravn.med@gmail.com.
Ugeskrift for Laeger
|February 13, 2018
Summary
A young man with viral meningitis developed a persistent, position-dependent headache. Diagnosis of post-dural puncture headache was confirmed, and while an epidural blood patch initially helped, subsequent treatments failed, highlighting the need to recognize orthostatic headache components.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Viral meningitis can present with various neurological complications.
- Headaches are a common symptom, but persistent, orthostatic headaches require further investigation.
Observation:
- A young male patient presented with fever and headache, diagnosed with viral meningitis.
- Post-discharge, he developed a persistent headache exacerbated by an upright position.
- This positional headache was initially attributed to the meningitis.
Findings:
- The patient was diagnosed with post-dural puncture headache (PDPH) 14 months after initial presentation.
- An initial epidural blood patch (EBP) provided temporary relief.
- Repeated EBP treatments were ultimately unsuccessful in resolving the headache.
Implications:
- This case underscores the importance of identifying and evaluating orthostatic symptoms in patients with persistent headaches.
- Recognizing PDPH, even months after an initial event, is crucial for appropriate management.
- The limitations of repeated EBP in refractory cases warrant consideration of alternative or adjunctive therapies.
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