Repeat epidural blood patch at the level of unintentional dural puncture and its neurologic complications: a case report.

Abstract

BACKGROUND:

Autologous epidural blood patch (AEBP) is effective for post-dural-puncture headache (PDPH). In some cases, repeat procedures are required for complete cure. In rare instances, severe adverse effects can occur. We present a case of neurologically complicated AEBPs, one of which was performed at the interspace of unintentional dural puncture (UDP).

CASE PRESENTATION:

A 40-year-old primigravida sustained UDP at the L2-3 interspace during combined spinal-epidural anesthesia for a scheduled cesarean section. She developed PDPH and underwent a single AEBP at L3-4. The PDPH recurred and she required another AEBP at L2-3, after which she reported radicular pains. A diagnosis of subdural hematoma and adhesive arachnoiditis was made. Her symptoms partially resolved in the following months.

CONCLUSION:

It may be prudent to reconsider the use of repeated AEBP and to avoid the interspace of UDP. A thorough evaluation is warranted to exclude treatable lesions when adverse effects occur.

• Authors: Kentaro Iga, Takeshi Murakoshi, Airi Kato, Keiichiro Kato, Shuhei Terada, Hiroko Konno, Shingo Irikoma, Takashi Suzuki, Mitsuru Matsushita, Yoshie Toba
• Journal: JA clinical reports (JA Clin Rep) Vol. 5 Issue 1 Pg. 14 (Feb 28 2019) ISSN: 2363-9024 [Electronic] Germany
• PMID: 32025902 (Publication Type: Journal Article)