Case report: delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy.
OBJECTIVE
To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy.


METHODS
A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontal-retroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment.


CONCLUSIONS
This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.
Department of Anesthesiology and Pain Medicine, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington 98105, USA. anjana.kundu@seattlechildrens.org
Anjana
A
Kundu
Yuko
Y
Sano
Paul S
PS
Pagel
D000293:Adolescent; D017217:Blood Patch, Epidural; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009192:Myelography; D020795:Photophobia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed