Prolonged post-dural puncture headache in a patient during treatment with selective serotonin reuptake inhibitor: a case report and animal experiment.
We report a case of prolonged post-dural puncture headache (PDPH) in a patient with panic disorder. A 41-year-old woman received spinal anesthesia for interstitial cystitis. She noticed headache after surgery but did not report it to her doctor. As her headache worsened, she was readmitted to the hospital and diagnosed with PDPH 1 month after surgery. She had panic disorder, controlled by treatment with a selective serotonin reuptake inhibitor, sertraline. Conservative treatments were performed for 1 week, but her headache persisted. Successful resolution of PDPH was achieved following two epidural blood patch applications. A recent study showed that the duration of PDPH was prolonged with a history of depression. Therefore, we conducted a reverse translational experiment to investigate the effects of sertraline on the production of cerebrospinal fluid (CSF) in rats. Our results demonstrated that a clinically relevant dose of sertraline decreased the production of CSF. Our findings imply that treatment with sertraline may have contributed to the development of prolonged PDPH in this case.
Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, Japan, takashika@kochi-u.ac.jp.
Takashi
T
Kawano
Tetsuya
T
Takahashi
Noriko
N
Kitaoka
Masataka
M
Yokoyama
D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000818:Animals; D017217:Blood Patch, Epidural / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D051299:Post-Dural Puncture Headache / Q000209:etiology* / Q000628:therapy; D051381:Rats; D017208:Rats, Wistar; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors
D017367:Selective Serotonin Reuptake Inhibitors