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Case report: delayed presentation of postural headache in an adolescent girl after microscopic lumbar discectomy. Can J Anaesth 2008 Oct;55(10):696-701

Date

10/07/2008

Pubmed ID

18835968

DOI

10.1007/BF03017746

Abstract

PURPOSE: To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy.

CLINICAL FEATURES: A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontal-retroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment.

CONCLUSION: This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.

Author List

Kundu A, Sano Y, Pagel PS

Author

Paul S. Pagel MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Blood Patch, Epidural
Brain
Diskectomy
Dura Mater
Female
Headache
Humans
Intervertebral Disc Displacement
Intracranial Hypotension
Lumbar Vertebrae
Magnetic Resonance Imaging
Myelography
Photophobia
Postoperative Complications
Tomography, X-Ray Computed
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