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Epidural Blood Patch in a Patient with a Hematological Malignancy
Ross Barman1, Jack McHugh2, Thomas O'Mara3
1Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Case Reports in Medicine
|February 23, 2023
Summary
Postdural puncture headache (PDPH) can occur after spinal procedures. An epidural blood patch effectively treated PDPH in an acute myeloid leukemia patient without spreading cancer cells.
Area of Science:
- Neurology
- Oncology
- Anesthesiology
Background:
- Postdural puncture headache (PDPH) is a common complication after lumbar puncture or neuraxial anesthesia.
- Conservative treatments like hydration and NSAIDs are often insufficient for severe PDPH.
- The epidural blood patch (EBP) is the gold standard for refractory PDPH.
Observation:
- Patients with hematological malignancies pose a unique challenge for EBP due to concerns of malignant cell seeding.
- This case report details a patient with acute myeloid leukemia (AML) who developed PDPH after intrathecal chemotherapy.
- The patient failed conservative management, necessitating consideration of EBP.
Findings:
- A multidisciplinary team and the patient discussed the risks and benefits of EBP in the context of AML.
- The patient underwent an EBP, which resulted in complete resolution of PDPH.
- No evidence of malignant cell spread into the neuraxis or cerebrospinal fluid was observed post-EBP.
Implications:
- EBP can be a safe and effective treatment for PDPH in select patients with hematological malignancies.
- This case supports the consideration of EBP in patients with AML experiencing refractory PDPH.
- Further research may clarify consensus guidelines for EBP in patients with hematological malignancies.
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