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Repeat epidural blood patch at the level of unintentional dural puncture and its neurologic complications: a case
Kentaro Iga1, Takeshi Murakoshi2, Airi Kato2
1Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan. ken.iga.kyoto@gmail.com.
Background:
Autologous epidural blood patch (AEBP) is effective for post-dural-puncture headache (PDPH). In some cases, repeat procedures are required for complete cure. In rare instances, severe adverse effects can occur. We present a case of neurologically complicated AEBPs, one of which was performed at the interspace of unintentional dural puncture (UDP).
Case Presentation:
A 40-year-old primigravida sustained UDP at the L2-3 interspace during combined spinal-epidural anesthesia for a scheduled cesarean section. She developed PDPH and underwent a single AEBP at L3-4. The PDPH recurred and she required another AEBP at L2-3, after which she reported radicular pains. A diagnosis of subdural hematoma and adhesive arachnoiditis was made. Her symptoms partially resolved in the following months.
Conclusion:
It may be prudent to reconsider the use of repeated AEBP and to avoid the interspace of UDP. A thorough evaluation is warranted to exclude treatable lesions when adverse effects occur.
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