Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture.

BACKGROUND AND OBJECTIVES

Unintentional dural puncture with a Tuohy epidural needle during the course of an epidural anesthetic may lead to a postdural puncture headache and double vision. We describe a parturient that developed left abducens nerve palsy after an epidural anesthetic for labor.

METHODS

A 32-year-old female developed a postdural puncture headache 1 day after an epidural anesthetic for labor. Over the next several days she began to complain of diplopia. Subsequent to this, she developed lateral rectus muscle palsy.

RESULTS

The lateral rectus palsy resolved spontaneously 8 weeks after the epidural anesthetic.

CONCLUSIONS

We believe that a dural puncture during an attempted epidural anesthetic resulted in cerebrospinal fluid (CSF) leakage with a consequent headache. The CSF leak caused traction on the sixth cranial nerve resulting in lateral rectus muscle palsy. An epidural blood patch performed after the onset of symptoms did not acutely resolve the abducens nerve palsy.