Background and Aims Intracranial hypertension is a serious complication after an epidural blood patch to treat post dural puncture headache (PDPH). The authors describe a clinical case of intracranial hypertension post epidural blood patch (IHPEBP) to highlight the importance of the differential diagnosis of PDPH after performing a neuraxial technique.
Methods 33-years old female, ASA II, admitted for elective cesarean section (CS). The procedure was uneventful under anesthetic combined spinal-epidural technique. There was no background history of gestational hypertension, neurological pathology, vascular malformations or cranioencephalic trauma. At 24h post CS, the patient presented a frontal and occipital headache at orthostatism, buzzing and photophobia, unresponsive to conservative analgesic. At 72 h post CS, the symptoms persisted, and an epidural blood-patch was performed, uneventful and with immediate relief of symptoms. Patient was discharged the day after.
Results Four days after hospital discharge, the patient returned to the emergency department, presenting headache relapse, without postural influence and visual disorders, with onset on that day. The venous cerebral CT scan revealed a ‘thin subdural hematic lamina’, with no other significant findings. She was evaluated by Ophthalmology and Neurology, who considered the IHPEBP to be the most likely cause of the headache.
Conclusions The lack of more widespread recognition of this condition is probably caused by a superficial similarity of presenting features: headache is the predominant symptom experienced by patients with IHPEBP and patients with PDPH. For a correct differential diagnosis, additional diagnostic tests and a multidisciplinary discussion should be considered. Lack of familiarity with this complication can result in misdiagnosis.
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