Bilateral subdural hygromas following dural puncture

A parturient reported a headache 20 hours following unintentional dural puncture during epidural placement for labour analgesia. It was positional, mild to moderate in severity with no focal neurological signs. Six days later, the headache became more severe. She developed a left sixth cranial nerve palsy. A CT brain revealed bilateral fronto-parietal subdural hygromas with no evidence of raised intracranial pressure (ICP). Following neurology and neurosurgical opinions, it was felt that there were no absolute contraindications to an epidural blood patch (EBP). Eight days following dural puncture, an EBP was performed. The headache immediately resolved. The sixth cranial nerve palsy resolved within a week of the EBP. There may be a role for neuroimaging in select cases of postdural puncture headache prior to EBP intervention such as those with localising neurological signs or atypical symptoms.