Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device.
OBJECTIVE
Complications related to cerebrospinal fluid (CSF) leak and low CSF pressure can occur following placement of an intrathecal drug delivery device.


METHODS
A 58-year-old man with chronic, intractable lower back pain underwent implantation of an intrathecal drug delivery device. On the fourth postoperative day, he developed a postural headache and diplopia with findings compatible with left sixth cranial nerve palsy. The headache subsequently became constant and nonpostural. Cranial magnetic resonance imaging was obtained that showed the presence of a posterior subdural intracranial hematoma. Conservative treatment for postdural puncture headache did not improve the symptomatology. Therefore, an epidural blood patch was performed that produced rapid improvement and eventual resolution of symptoms.


CONCLUSIONS
Intrathecal catheter implantation can result in CSF loss that might not resolve promptly with conservative therapy. In this case, epidural blood patch proved to be a safe and effective form of treatment.
Velarde
C A
CA
Department of Anesthesiology and Critical Care Medicine, the University of New Mexico, Albuquerque 87131-5216, USA.
Zuniga
R E
RE
Leon
R F
RF
Abram
S E
SE
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy; D017217:Blood Patch, Epidural; D003389:Cranial Nerve Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D004172:Diplopia / Q000139:chemically induced; D020199:Hematoma, Subdural, Acute / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D009020:Morphine