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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

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Delayed approach to postdural puncture headache.

Haiyan Guo¹, Joseph Villaluz¹

¹Department of Anesthesiology, Kaweah Delta Health Care District, Visalia, California, USA haiyanhelen.guo@gmail.com Jvillaluz.anesthesiology@gmail.com.

BMJ Case Reports

|September 22, 2023

Summary

This summary is machine-generated.

A postpartum patient experienced atypical postdural puncture headache symptoms, including severe back pain and arm symptoms, without a positional headache. Conservative management followed by an epidural blood patch resolved her condition.

Keywords:

anaesthesia obstetrics, gynaecology and fertility

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Area of Science:

Neurology
Anesthesiology
Radiology

Background:

Postdural puncture headache (PDPH) typically presents with positional headache.
Atypical presentations of PDPH can mimic other neurological conditions.

Observation:

A postpartum patient presented with severe interscapular pain and upper extremity radiculopathy, but no headache.
Initial symptoms were atypical for postdural puncture headache.
Magnetic Resonance Imaging (MRI) revealed a significant cerebrospinal fluid (CSF) leak causing spinal cord mass effect and cauda equina stenosis.

Findings:

Cerebrospinal fluid (CSF) leak was diagnosed via MRI.
Conservative management was initiated due to concerns about the narrow epidural space for an epidural blood patch (EBP).
Subsequent imaging showed CSF resorption, leading to a successful EBP on day 7.

Implications:

This case highlights the importance of considering atypical presentations of postdural puncture headache.
Early diagnosis through advanced imaging like MRI is crucial for appropriate management.
Successful conservative management followed by epidural blood patch can lead to favorable outcomes in complex PDPH cases.