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Incidental finding of an arachnoid cyst in a patient presenting with features of postural headache after spinal anesthesia.

Lee SH, Kang JG, Cho WJ, Kim K, Park JH - Korean J Anesthesiol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

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Postural headache can be caused by several underlying etiologies, therefore, when postural headache develops after spinal anesthesia, differential diagnosis and evaluation are imperative, despite a clear history of dural puncture and prominent features of headache with postural changes, indicating postdural puncture headache (PDPH)... He had not had any previous history of headache, neurologic signs or back pain, and his preoperative evaluation was normal... After the surgery, the patient was transferred to the recovery room, and was sent to the ward after the dermatomal level dropped to thoracic level ten (T10)... He did not complain of any discomfort or medical attention... A neurosurgical opinion was consulted to assess the possible increase of intracranial pressure (ICP) owing to the cyst and determine whether any intervention was needed... The patient did not manifest any neurologic abnormality or a deficit of cranial nerve abnormality... An epidural blood patch was also recommended if the headache persisted... There are other reports of rare etiologies for postural headache that are unrelated to low ICP, such as herniation of a giant posterior fossa arachnoid cyst or cerebellar hemorrhage... In our patient, clinical features were that of PDPH, however, upon imaging of the brain, an arachnoid cyst was incidentally found... Most low ICP headaches are resolved spontaneously or respond to bed rest, intravenous hydration, and analgesics... An autologous blood patch can be considered if 24 hours of conservative treatment does not suffice... In considering intracranial pathology, it should be kept in mind that intracranial hypotension can also lead to intracranial hemorrhage through tearing of the bridging dural veins... PDPH also needs to be differentiated from headache associated with pneumocephalus... In association with the latter mechanism, pneumocephalus may also develop from spinal anesthesia in rare cases, although most occur in epidural anesthesia.

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A computed tomography (CT) scan showing an arachnoid cyst at posterior cranial fossa.
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Figure 1: A computed tomography (CT) scan showing an arachnoid cyst at posterior cranial fossa.

Mentions: Upon an outpatient urologic clinic visit two days after discharge, the patient complained of continued headache despite oral analgesics, acetaminophen 650 mg (Tylenol® ER TAB 650 mg, Janssen Korea Ltd, Seoul, Korea) with postural aggravation. In a neurologist's opinion, he was suspected to have PDPH after spinal anesthesia; a brain computed tomography image was taken, which revealed an arachnoid cyst posterior to the cerebellum (Fig. 1). A neurosurgical opinion was consulted to assess the possible increase of intracranial pressure (ICP) owing to the cyst and determine whether any intervention was needed. The patient did not manifest any neurologic abnormality or a deficit of cranial nerve abnormality. The neurosurgical and neurologic consultation concluded that a low ICP was accounted for his headache, and that a conservative management may suffice. An epidural blood patch was also recommended if the headache persisted. The patient came back to the outpatient clinic 4 days after and he reported a complete recovery from his headache.


Incidental finding of an arachnoid cyst in a patient presenting with features of postural headache after spinal anesthesia.

Lee SH, Kang JG, Cho WJ, Kim K, Park JH - Korean J Anesthesiol (2014)

A computed tomography (CT) scan showing an arachnoid cyst at posterior cranial fossa.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4295981&req=5

Figure 1: A computed tomography (CT) scan showing an arachnoid cyst at posterior cranial fossa.
Mentions: Upon an outpatient urologic clinic visit two days after discharge, the patient complained of continued headache despite oral analgesics, acetaminophen 650 mg (Tylenol® ER TAB 650 mg, Janssen Korea Ltd, Seoul, Korea) with postural aggravation. In a neurologist's opinion, he was suspected to have PDPH after spinal anesthesia; a brain computed tomography image was taken, which revealed an arachnoid cyst posterior to the cerebellum (Fig. 1). A neurosurgical opinion was consulted to assess the possible increase of intracranial pressure (ICP) owing to the cyst and determine whether any intervention was needed. The patient did not manifest any neurologic abnormality or a deficit of cranial nerve abnormality. The neurosurgical and neurologic consultation concluded that a low ICP was accounted for his headache, and that a conservative management may suffice. An epidural blood patch was also recommended if the headache persisted. The patient came back to the outpatient clinic 4 days after and he reported a complete recovery from his headache.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Postural headache can be caused by several underlying etiologies, therefore, when postural headache develops after spinal anesthesia, differential diagnosis and evaluation are imperative, despite a clear history of dural puncture and prominent features of headache with postural changes, indicating postdural puncture headache (PDPH)... He had not had any previous history of headache, neurologic signs or back pain, and his preoperative evaluation was normal... After the surgery, the patient was transferred to the recovery room, and was sent to the ward after the dermatomal level dropped to thoracic level ten (T10)... He did not complain of any discomfort or medical attention... A neurosurgical opinion was consulted to assess the possible increase of intracranial pressure (ICP) owing to the cyst and determine whether any intervention was needed... The patient did not manifest any neurologic abnormality or a deficit of cranial nerve abnormality... An epidural blood patch was also recommended if the headache persisted... There are other reports of rare etiologies for postural headache that are unrelated to low ICP, such as herniation of a giant posterior fossa arachnoid cyst or cerebellar hemorrhage... In our patient, clinical features were that of PDPH, however, upon imaging of the brain, an arachnoid cyst was incidentally found... Most low ICP headaches are resolved spontaneously or respond to bed rest, intravenous hydration, and analgesics... An autologous blood patch can be considered if 24 hours of conservative treatment does not suffice... In considering intracranial pathology, it should be kept in mind that intracranial hypotension can also lead to intracranial hemorrhage through tearing of the bridging dural veins... PDPH also needs to be differentiated from headache associated with pneumocephalus... In association with the latter mechanism, pneumocephalus may also develop from spinal anesthesia in rare cases, although most occur in epidural anesthesia.

No MeSH data available.


Related in: MedlinePlus