Postdural Puncture Headache in a Patient With Thoracic Arachnoid Web With Known Joint Hypermobility: Case Report

Patients with connective tissue disorders (CTDs), such as Ehlers-Danlos syndrome, can present unique challenges in the management of spinal pathology and procedural complications due to underlying tissue fragility and susceptibility to dural ruptures. Thus, there is a need for less invasive diagnostic and therapeutic care in this population.

We present a case of a 48-year-old woman with joint hypermobility who developed acute-on-chronic back pain and radicular symptoms. Imaging revealed an L5-S1 radiculopathy and a thoracic arachnoid cyst. During inpatient rehabilitation, she experienced a postdural puncture headache (PDPH) following a thoracic spine myelogram refractory to conservative measures and the gold standard, epidural blood patches (EBPs), necessitating the need for management strategies tailored to her complex clinical profile.

Managing PDPH in patients with CTDs requires careful consideration of alternative therapeutic options and potential complications associated with standard treatments like EBPs.

This case highlights the need for individualized approaches to minimize procedural risks while optimizing patient outcomes in this population.