title: Orgasmic dural tear: an unusual delayed presentation of postural headache following lumbar discectomy.
abstract: A 28-year-old woman presented with a severe unremitting frontal postural headache associated with photophobia. This started immediately after standing following reaching orgasm during sexual intercourse. Fifty-two days previously, the patient underwent bilateral L4-L5 decompression laminotomies and a left L4-L5 discectomy for excision of a large herniated intervertebral disc. Subarachnoid haemorrhage was excluded with a CT scan. Brain and lumbar MRI showed enhancement of the pachymeninges and a cerebrospinal fluid (CSF) leak into the deep soft tissue planes. Conservative treatment for 5 days failed to alleviate the patient's symptoms. An exploration and repair of a dural tear was performed. Subsequently, the headache subsided but the patient developed a low-grade infection requiring 12 weeks of antibiotics. Six months later the patient was asymptomatic. This is the first case report of a delayed presentation of a dural tear occurring during sexual intercourse following lumbar surgery.
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Dannawi
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK.
authors.forename: Shirley Evelyn
authors.initials: SE
authors.lastname: Lennon
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK.
authors.forename: Ammar
authors.initials: A
authors.lastname: Zaidan
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK.
authors.forename: Rabi
authors.initials: R
authors.lastname: Khazim
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D009948:Orgasm / Q000502:physiology*; D011187:Posture; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome