Emergency Medicine Images: Headache After a Lumbar Puncture

Abstract

A 34-year-old man presented to the emergency department for a persistent, positional headache 3 weeks after a routine lumbar puncture (LP) for the workup of multiple sclerosis. The headache started gradually approximately 1 week after the uneventful LP and consistently improved with lying flat and worsened when upright. At a previous ED visit for this headache, an epidural blood patch was considered for postdural puncture headache (PDPH); however, the anesthesia service did not think a blood patch would be better than conservative treatment, given the usual benign course and the expectation for near-term resolution of symptoms with PDPH. With the patient experiencing persistent symptoms affecting his daily activities despite home analgesics, the ED clinician ordered a noncontrast head computed tomography scan (CT) (Figures 1 and 2). Figure 2Coronal noncontrast head computed tomographyt. There are bilateral convexity subdural hematomas (arrows) and subdural hematoma along the interhemispheric fissure (chevrons). The lateral ventricles partially effaced. View Large Image Figure Viewer Download Hi-res image Brian J. Ahern is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX. ORCID identifier: http://orcid.org/0000-0002-5701-3561. Lisa M. Jin is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX. Sean M. Sylvia is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX.