Intrathecal hematoma and sacral radiculitis following repeat epidural blood patch

Area of Science:

• Anesthesiology
• Neurology
• Radiology

Background:

• Postdural puncture headache (PDPH) is a debilitating complication following dural puncture during neuraxial anesthesia.
• Conservative management and epidural blood patches (EBPs) are common treatments for PDPH.
• Neurologic complications secondary to EBPs are considered rare.

Purpose of the Study:

• To report an uncommon complication of epidural blood patch (EBP) in a patient with postdural puncture headache (PDPH).
• To highlight the potential for EBPs to cause neurologic sequelae, such as sacral radiculitis.
• To emphasize the utility of magnetic resonance imaging (MRI) in diagnosing such complications.

Main Methods:

• Case report of a 32-year-old female experiencing PDPH after epidural anesthesia.
• Initial conservative management followed by two EBPs.
• Diagnostic workup included magnetic resonance imaging (MRI) due to persistent severe back pain and radicular symptoms.

Main Results:

• The patient developed severe back pain radiating to the buttocks after the second EBP.
• MRI revealed intrathecal blood, consistent with sacral radiculitis.
• This case suggests neurologic complications from EBPs may be underrecognized.

Conclusions:

• Epidural blood patches, while effective for PDPH, can rarely lead to significant neurologic complications.
• Sacral radiculitis secondary to intrathecal blood from an EBP is a potential, albeit uncommon, outcome.
• Early diagnosis with MRI and a multidisciplinary approach are crucial for managing complicated PDPH cases.