Spinal meningocele due to iatrogenic dural puncture during epidural analgesia for childbirth: 5-year history of headache with a spinal etiology.
Patients undergoing epidural injection for labor pains occasionally sustain iatrogenic inadvertent puncture of the dura with or without damage to the underlying neurological structures. This may be associated with CSF leakage, headache, neurological deficit, and infection. Rarely, the headache persists for years. To the authors' knowledge, chronic headache due to acquired spinal meningocele featuring as a duplicated dural sac, as a sequela of traumatic inadvertent dural puncture, has not been previously reported. The authors report a case of a 20-year-old woman with persistent headaches following an epidural injection. Five years later, the persistent headache was found to be due to a large acquired spinal meningocele. The operative removal of the meningocele led to resolution of headaches. This report highlights the importance of considering a spinal condition as a culprit for chronic headache and postulates a mechanism for the formation of the acquired spinal meningocele appearing as a duplicated dural sac. The authors recommend early MR imaging of the spine for any persisting headache that has a history of attempted spinal access. If an acquired spinal meningocele collection is found, exploration with a view to complete removal of the sac should be considered. To the authors' knowledge, this is the first case report depicting a rare, treatable cause of chronic spinal hypotension resulting in headaches.
Nurboja
Besnik
B
Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom. bnurboja@doctors.org.uk
Rezajooi
Kia
K
Newton
Mary C
MC
Casey
Adrian T H
AT
D015360:Analgesia, Epidural / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D013129:Spinal Puncture / Q000009:adverse effects*; D055815:Young Adult