Published in:
01-10-2019 | Conservative Therapy | Images in Anesthesia
Postdural puncture headache with extensive spread of lumbar-cervical epidural cerebrospinal fluid
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 10/2019
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A 39-yr-old woman experienced inadvertent dural puncture during labour epidural placement at the L3-4 level. After an otherwise uncomplicated vaginal delivery, she developed a headache and severe neck pain without weakness, numbness, or cranial nerve dysfunction. She also complained of an electrical sensation down her spine when flexing her neck, consistent with Lhermitte’s phenomenon – generally a sign of demyelination or spinal cord compression but also associated with postdural puncture headache (PDPH).1 Magnetic resonance imaging revealed epidural cerebrospinal fluid (CSF) extending from vertebral level C3 to L5-S1 (Figure).
Figure
Magnetic resonance images (MRI) of the spine. A) Axial T2-weighted images of the cervical C7 region show epidural fluid (white) in a dorsal location. B) Axial T2-weighted image of the lumbar L1 region shows epidural fluid (white) in both ventral and dorsal locations. The cauda equina is visualized. C) Sagittal T2-weighted image shows epidural fluid (white) throughout the cervical, thoracic, and lumbar regions. The epidural fluid collection has displaced the thecal sac and spinal cord anteriorly
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