A complication of an epidural blood patch

Abstract

C. Subdural hematoma. Epidural blood patch (EBP) is generally accepted as an effective and relatively low risk therapeutic option for post dural puncture headache, as well spontaneous spinal cerebrospinal fluid (CSF) leak in patients not responding to conservative management [[1]Mokri B. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks.Headache. 2013; 53: 1034-1053Crossref PubMed Scopus (196) Google Scholar]. Subdural hematoma (SDH) after EBP is a very rare complication. As in the case described by Verduzco et al., our patients also demonstrated an eight segment spread of the hematoma [[2]Verduzco L.A. Atlas S.W. Riley E.T. Subdural hematoma after an epidural blood patch.Int J Obstet Anesth. 2012; 21: 189-192Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar]. There are generally three predominant theories for development of SDH after EBP [3Riley C.A. Spiegel J.E. Complications following large–volume epidural blood patches for postdural puncture headache.J Clin Anesth. 2009; 21: 355-359Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 4Devroe S. Van de Velde M. Demaerel P. et al.Spinal subdural hematoma after an epidural blood patch.Int J Obstet Anesth. 2015; 24: 288-289Abstract Full Text Full Text PDF Scopus (10) Google Scholar]. One is that the initial dural puncture with the Tuohy needle created a means of communication between the epidural and subdural spaces. The other is that the Tuohy needle was in the subdural space during the EBP with the blood injected into the subdural space. A third possibility is that both events occurred simultaneously. Intrathecal injection of an EBP has also been reported following accidental dural puncture with MRI demonstrating the intrathecal hematoma [[5]Kalina P. Craigo P. Weingarten T. Intrathecal injection of epidural blood patch.Emerg Radiol. 2004; 11: 56-59Crossref PubMed Scopus (38) Google Scholar]. A complication of an epidural blood patchJournal of Clinical NeuroscienceVol. 31PreviewA 58-year-old woman presented 1 week following an epidural blood patch (EBP) performed due to spontaneous cerebrospinal fluid (CSF) leak (diagnosed by intracranial MRI findings of CSF hypotension obtained for headaches). A spine MRI was performed as part of the continuing work-up to identify the source of the CSF leak (Fig. 1). She was otherwise asymptomatic. Full-Text PDF