Postdural Puncture Headache in a Patient With Thoracic Arachnoid Web With Known Joint Hypermobility: Case Report
Krish Tejas Bharat1, Ryan Mortman1, Patricia Maina1
1Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA.
Pain Medicine Case Reports
|September 3, 2025
Summary
Managing postdural puncture headaches (PDPH) in patients with connective tissue disorders (CTDs) requires tailored strategies. This case emphasizes individualized care to mitigate risks and improve outcomes for patients with fragile tissues.
Area of Science:
- Neurosurgery
- Anesthesiology
- Rheumatology
Background:
- Connective tissue disorders (CTDs) present challenges in spinal procedures due to tissue fragility.
- Patients with CTDs are susceptible to dural ruptures and procedural complications.
- Less invasive diagnostic and therapeutic options are needed for CTD patients with spinal pathology.
Observation:
- A 48-year-old woman with joint hypermobility developed back pain and radiculopathy, with imaging showing L5-S1 radiculopathy and a thoracic arachnoid cyst.
- She experienced a severe postdural puncture headache (PDPH) after a thoracic myelogram, which was refractory to conservative treatment and epidural blood patches (EBPs).
Findings:
- Standard treatments for PDPH, such as EBPs, may be less effective or carry higher risks in patients with CTDs.
- Management of PDPH in this population necessitates exploring alternative therapeutic strategies.
Implications:
- Individualized treatment approaches are crucial for CTD patients undergoing spinal procedures to minimize risks.
- Optimizing patient outcomes requires careful consideration of potential complications and tailored management plans for PDPH in CTDs.
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