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Background and Aims Complications of regional anesthesia (RA), anesthesiological challenge and problem.Post dural puncture headache (PDPH) is considered the most common, almost expected.Pulsating headache after RA initially occipital with shoulder and neck pain,diffuse character,nausea,vomitingis initially defined as PDPH.Is it always like that?

Methods Patient,30 years old,scheduled for inguinal hernia surgery.Preoperative unremarkable.The operation was performed in conditions of RA (L3-L4 spinal block),passed without complications(hemodynamic-respiratory stable). Postoperatively without complaints.On the second day,a severe headache of occipital postural character developed with nausea and vomiting. Neurologist consulted.Findings unremarkable-diagnosis of PDPH.On the third day,an epileptic attack followed by confusion and disorientation.An MSCT-hyperdensity was performed with a postcontrast deficit of the posterior segment of the sagittal sinus.Neurological findings indicate severe left-sided weakness,maintenance of psychomotor slowness with alert consciousness and preserved verbal communication.Anticoagulant (Fraxiparin 0.9ml sc/12h)was prescribed.Partial thrombosis of the sagittal sinus confirmed by NMR venography.After discharge, along with anticoagulants,an antiepileptic was also introduced. After 6 months control NMR-finding is completely normal,without the previously described defect.The patient feels well,without subjective complaints and repeated epileptic attacks.

Results PDPH is part of spectrum of differential diagnoses,closely related but different therapeutic strategies-meningitis,encephalitis,tension,lactation and cluster headache,cerebral venous thrombosis (CVT),subdural hematoma and intracranial mass. CVT-venous thromboembolism 4-6 patients per million patients per year with non-specific symptomatology.CVT defines:increasing headache,standing up does not increase it, analgesic non-responder.PDPH should always be viewed as a possible cause of postural headache, not as a definitive diagnosis,especially in the younger population-pregnancy,obesity and after COVID-19.

Conclusions Timely diagnosis of CVT and early introduction of anticoagulants is crucial along with antiedematous and antiepileptic therapy.