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Bilateral subdural hygromas following dural puncture
Roisin McCarthy1, David Burke2, Jane Bruton2
1Department of Anaesthesiology, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland rcarthy3@gmail.com.
BMJ Case Reports
|August 25, 2025
Summary
A severe headache and cranial nerve palsy following labor epidural analgesia resolved after an epidural blood patch. Neuroimaging may aid in selecting patients for this intervention, especially those with neurological signs.
Area of Science:
- Neurology
- Anesthesiology
- Neurosurgery
Background:
- Unintentional dural puncture during epidural placement can lead to postdural puncture headache (PDPH).
- PDPH can be associated with neurological complications, such as cranial nerve palsies.
- Subdural hygromas are a rare complication of PDPH.
Purpose of the Study:
- To report a case of PDPH with sixth cranial nerve palsy and subdural hygromas.
- To discuss the role of neuroimaging and epidural blood patch (EBP) in managing complex PDPH cases.
Main Methods:
- A parturient experienced positional headache and subsequent left sixth cranial nerve palsy after an unintentional dural puncture.
- CT brain revealed bilateral subdural hygromas without elevated intracranial pressure.
- An epidural blood patch was performed 8 days after dural puncture.
Main Results:
- The epidural blood patch provided immediate resolution of the headache.
- The sixth cranial nerve palsy resolved within one week post-EBP.
- The patient had no contraindications for EBP despite subdural hygromas.
Conclusions:
- Epidural blood patch is an effective treatment for PDPH, even in the presence of subdural hygromas.
- Neuroimaging may be beneficial in selected PDPH cases with neurological signs or atypical symptoms prior to EBP.
