Post-dural puncture headache following lumbar spinal drain: an atypical presentation with cognitive symptoms

Post-dural puncture headache is a consequence of cerebrospinal fluid loss, leading to reduced intracranial pressure. Its classical symptoms include a frontal-occipital headache which is worse on standing, neck stiffness, nausea, hearing loss and photophobia. In this report, we describe an atypical presentation of post-dural puncture headache in a 72-year-old woman following an endovascular repair of an aortic aneurysm, before which a lumbar spinal drain was placed to reduce the risk of spinal cord ischemia. Following drain removal, the patient developed hypoactive delirium, challenges with both depth perception and fine motor skills and a mild headache. An epidural blood patch was performed, which resulted in the complete resolution of her symptoms. This case highlights an atypical presentation of post-dural puncture headache in an older patient, in whom the major symptoms were cognitive. Cerebrospinal fluid leakage should be considered as a cause of postoperative delirium in patients who have undergone neuraxial anaesthesia.