title: [Refractory headache after epidural catheter placement in a girl in whom epidural blood patches were ineffective].
abstract: A 12-year-old girl who had received epidural catheter placement for an orthopedic surgery developed postural headache on postoperative day (POD) 1 which resolved in 24 hours. She was discharged on POD 6 but readmitted on POD 16 for headache accompanied by nausea and photophobia. On POD 17 and 35 she received epidural blood patches (EBPs) with 15 ml and 20 ml of autologous blood, respectively and her headache disappeared shortly after the second EBP. Laboratory data were normal and cranial CT on POD 16 and MR imaging on POD 33 demonstrated no abnormalities. She was discharged on POD 47. On POD 80 she was readmitted for a recurrent headache. She was referred to a doctor specializing in headache in another institution and advised to lead her usual daily life. She went back to school on POD 100. Headache gradually and completely disappeared on the POD 200. It took more than 100 days for her to regain her usual life. In conclusion, in adolescents whose symptoms and atypical, psychosomatic disorder should be taken into consideration as a differential diagnosis and a referral to a specialist is important.
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Seri
authors.initials: S
authors.lastname: Tsuru
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Tachibana
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Kayo
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Orthopedics, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tamura
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Muneyuki
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Department of Anesthesia and Intensive Care, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi 594-1101.
authors.forename: Keiko
authors.initials: K
authors.lastname: Kinouchi
mesh_terms: D017217:Blood Patch, Epidural; D002648:Child; D005260:Female; D006801:Humans; D008511:Medicine; D009325:Nausea; D019637:Orthopedic Procedures; D018710:Pain Clinics; D020795:Photophobia; D051299:Post-Dural Puncture Headache / Q000209:etiology* / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D000297:Psychology, Adolescent; D011602:Psychophysiologic Disorders / Q000150:complications; D012008:Recurrence; D012017:Referral and Consultation; D013997:Time Factors; D017211:Treatment Failure