Lumbar subarachnoid hematoma following an epidural blood patch for meningeal puncture headache related to the implantation of an intrathecal drug delivery system

Erik Hustak, Mitchell P. Engle, Ashwin Viswanathan, Dhanalakshmi Koyyalagunta

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explantation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication.

Original languageEnglish (US)
JournalPain Physician
Volume17
Issue number3
StatePublished - 2014
Externally publishedYes

Fingerprint

Epidural Blood Patch
Drug Delivery Systems
Punctures
Hematoma
Headache
Epidural Space
Dura Mater
Laminectomy
Morbidity

Keywords

  • Complications
  • Epidural blood patch
  • Implantable pain therapies
  • Intrathecal drug delivery
  • Meningeal puncture headache
  • Pain
  • Pain procedures
  • Post dural puncture headache
  • Spinal subarachnoid hematoma
  • Tinnitus
  • Ziconotide

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Lumbar subarachnoid hematoma following an epidural blood patch for meningeal puncture headache related to the implantation of an intrathecal drug delivery system. / Hustak, Erik; Engle, Mitchell P.; Viswanathan, Ashwin; Koyyalagunta, Dhanalakshmi.

In: Pain Physician, Vol. 17, No. 3, 2014.

Research output: Contribution to journalArticle

@article{0b5c0ec27d83423399753ec427beed9a,
title = "Lumbar subarachnoid hematoma following an epidural blood patch for meningeal puncture headache related to the implantation of an intrathecal drug delivery system",
abstract = "Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explantation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication.",
keywords = "Complications, Epidural blood patch, Implantable pain therapies, Intrathecal drug delivery, Meningeal puncture headache, Pain, Pain procedures, Post dural puncture headache, Spinal subarachnoid hematoma, Tinnitus, Ziconotide",
author = "Erik Hustak and Engle, {Mitchell P.} and Ashwin Viswanathan and Dhanalakshmi Koyyalagunta",
year = "2014",
language = "English (US)",
volume = "17",
journal = "Pain Physician",
issn = "1533-3159",
publisher = "Association of Pain Management Anesthesiologists",
number = "3",

}

TY - JOUR

T1 - Lumbar subarachnoid hematoma following an epidural blood patch for meningeal puncture headache related to the implantation of an intrathecal drug delivery system

AU - Hustak, Erik

AU - Engle, Mitchell P.

AU - Viswanathan, Ashwin

AU - Koyyalagunta, Dhanalakshmi

PY - 2014

Y1 - 2014

N2 - Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explantation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication.

AB - Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater. We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explantation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication.

KW - Complications

KW - Epidural blood patch

KW - Implantable pain therapies

KW - Intrathecal drug delivery

KW - Meningeal puncture headache

KW - Pain

KW - Pain procedures

KW - Post dural puncture headache

KW - Spinal subarachnoid hematoma

KW - Tinnitus

KW - Ziconotide

UR - http://www.scopus.com/inward/record.url?scp=84901264198&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901264198&partnerID=8YFLogxK

M3 - Article

VL - 17

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 3

ER -