title: Unintentional cervical dural tap treated with lumbar blood patch.
abstract: Cervical radicular pain presents itself as pain radiating from the neck to the arm. If conservative treatment fails, a cervical epidural steroid injection can be considered. A rare but possible complication resulting from the interlaminar approach is unintentional cervical dural puncture that may result in post-dural puncture headache (PDPH). Dural puncture from an interlaminar cervical epidural injection reportedly range from 0.25% to 2.65%. An epidural blood patch is a possible treatment option when conservative treatment fails. Relief could be secondary to 'sealing' of the dural tear from the clotted blood and reestablishment of physiological intracranial pressure. Another theory is an increase in the subarachnoid pressure from the injected blood. The increased pressure may restore normal intracranial pressure. We describe 2 cases of cervical PDPH treated with lumbar epidural blood patch. In 1 case, there was complete resolution of the symptoms and in the other case, there was great improvement of symptoms and a high thoracic blood patch was performed to resolve the remaining headache.
authors.affiliation: Department of Anesthesiology, Intensive Care, Emergency Care and Pain Therapy, AZ Turnhout, Turnhout, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lebrun
authors.forename: Dirk
authors.initials: D
authors.lastname: Peek
authors.forename: Pascal
authors.initials: P
authors.lastname: Vanelderen
authors.forename: Jan
authors.initials: J
authors.lastname: Van Zundert
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D002574:Cervical Vertebrae; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D051299:Post-Dural Puncture Headache / Q000503:physiopathology / Q000628:therapy*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: cervical dural puncture; cervical dural tap; lumbar epidural blood patch; post-dural puncture headache