Unrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging.
Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. We report a case of a parturient who developed disabling intracranial hypotension and diplopia following accidental dural puncture during apparently uneventful epidural catheter insertion. Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.
Corbonnois
G
G
Service d'anesthésie-réanimation chirurgicale, hôpital Central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
O'Neill
T
T
Brabis-Henner
A
A
Schmitt
E
E
Hubert
I
I
Bouaziz
H
H
D020434:Abducens Nerve Diseases / Q000209:etiology; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D001921:Brain / Q000473:pathology; D004172:Diplopia / Q000209:etiology; D004388:Dura Mater / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology; D008279:Magnetic Resonance Imaging; D051299:Post-Dural Puncture Headache / Q000628:therapy; D011247:Pregnancy