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Headache that will not go away...Third ED visit is the charm?
Alice Holmquist1, Daniel Calick2, John Perkins2
1Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States.
The American Journal of Emergency Medicine
|July 6, 2024
Summary
Subdural hematoma is a rare complication of epidural analgesia. Early recognition is crucial, as symptoms like headache can mimic post-dural puncture headaches, delaying diagnosis.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Headache is a common symptom following epidural analgesia and lumbar puncture.
- Post-dural puncture headache (PDPH) is a frequent diagnosis in emergency departments.
- Subdural hematoma (SDH) is an uncommon but serious complication of these procedures.
Observation:
- A young female presented with headache after childbirth epidural analgesia.
- She received two emergency department visits treated for presumed PDPH.
- Computed tomography (CT) imaging on the third visit revealed bilateral subdural hematomas.
Findings:
- The patient's symptoms were initially misdiagnosed as PDPH.
- Delayed diagnosis of subdural hematoma occurred due to symptom overlap.
- CT scan was essential for identifying the subdural hematoma.
Implications:
- Clinicians must maintain a high index of suspicion for SDH in patients with persistent or severe headaches post-procedure.
- Rethinking the diagnosis is critical if initial PDPH treatment fails or symptoms worsen.
- Prompt neuroimaging is vital to avoid delayed diagnosis and potential neurological sequelae.
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