title: Spontaneous intracranial hypotension following epidural anesthesia: a case report.
abstract: We report a case of refractory spontaneous intracranial hypotension (SIH) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post-dural puncture headache (PDPH). A 56-year-old man received a successful appendectomy under epidural anesthesia performed at a T11-T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a PDPH was diagnosed. However, the patient did not respond well to conservative treatment. Three months later, the first epidural blood patch was performed at the L3-L4 level, however, the patient still had an orthostatic headache. Five days later, spine magnetic resonance imaging showed multiple meningeal diverticulum in the cervicothoracic junction, and computerized tomography myelography demonstrated a C5-C6 spinal dural tear suggesting cerebrospinal fluid leaks. Finally, the patient was diagnosed as SIH and received a second epidural blood patch at the T2-T3 level and responded with improvements in symptomatology. The patient was then discharged, and at a 2-year follow-up, he had fully recovered except for some remaining neck stiffness. This case illustrates that SIH was misdiagnosed as PDPH because of the common clinical symptoms and potentially confounding events (epidural/spinal anesthesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of SIH, a timely epidural blood patch should be considered as soon as the diagnosis is established.
authors.affiliation: Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: X
authors.initials: X
authors.lastname: An
authors.affiliation: Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: F
authors.initials: F
authors.lastname: He
authors.affiliation: Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: X
authors.initials: X
authors.lastname: Fang
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001062:Appendectomy; D065634:Cerebrospinal Fluid Leak / Q000209:etiology; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000293:injuries; D006261:Headache / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D051299:Post-Dural Puncture Headache / Q000175:diagnosis; D014057:Tomography, X-Ray Computed