Intractable post dural puncture headache in a patient with undiagnosed intrathoracic meningocele
Dr. Reena1
, Subash Sankaralingam1, Swati Singh2, Amrita Rath1, J. Manikandan1, Ashutosh Vikram3
1Department of Anesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
2Department of Anesthesiology, Indira Gandhi Institute of Medical Science, Patna, India
3Department of Orthopedics, Baba Kinaram Government Medical College, Chandauli, India
Keywords: Dural puncture, Epidural blood patch, Intrathoracic meningocele, Neurofibromatosis, Neuroimaging, PDPH.
Abstract
Post dural puncture headache (PDPH) is a troublesome complication of dural puncture. Although its risk factors and management have been extensively discussed in the literature, the underlying cause may sometimes remain unclear, making treatment challenging for anaesthesiologists. We describe a noteworthy case of PDPH following spinal anaesthesia administered for an emergency cesarean section in a patient with known neurofibromatosis. Despite conservative and pharmacological treatment, followed by an autologous epidural blood patch, no symptomatic relief was achieved. Neuroimaging of the brain and spine revealed a large intrathoracic meningocele (IM). Although rare, intrathoracic meningocele should be considered in patients with neurofibromatosis who develop intractable PDPH after dural puncture, with neuroimaging being the most effective diagnostic tool.