Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
J Neurosurg Spine. 2009 Dec;11(6):764-7. doi: 10.3171/2009.7.SPINE08893.
Patients undergoing epidural injection for labor pains occasionally sustain iatrogenic inadvertent puncture of the dura with or without damage to the underlying neurological structures. This may be associated with CSF leakage, headache, neurological deficit, and infection. Rarely, the headache persists for years. To the authors' knowledge, chronic headache due to acquired spinal meningocele featuring as a duplicated dural sac, as a sequela of traumatic inadvertent dural puncture, has not been previously reported. The authors report a case of a 20-year-old woman with persistent headaches following an epidural injection. Five years later, the persistent headache was found to be due to a large acquired spinal meningocele. The operative removal of the meningocele led to resolution of headaches. This report highlights the importance of considering a spinal condition as a culprit for chronic headache and postulates a mechanism for the formation of the acquired spinal meningocele appearing as a duplicated dural sac. The authors recommend early MR imaging of the spine for any persisting headache that has a history of attempted spinal access. If an acquired spinal meningocele collection is found, exploration with a view to complete removal of the sac should be considered. To the authors' knowledge, this is the first case report depicting a rare, treatable cause of chronic spinal hypotension resulting in headaches.
患者在接受硬膜外分娩镇痛时，偶尔会发生医源性意外刺破硬脑膜，导致潜在的神经结构损伤。这可能与脑脊液漏、头痛、神经功能缺损和感染有关。罕见情况下，头痛可持续数年。据作者所知，因创伤性意外刺破硬脑膜而继发的获得性脊髓脑脊膜膨出导致慢性头痛，以前尚未有报道。作者报告了一例 20 岁女性，在硬膜外注射后持续头痛。5 年后，持续性头痛被发现是由于一个大的获得性脊髓脑脊膜膨出。手术切除脑脊膜膨出后头痛缓解。本报告强调了将脊柱疾病作为慢性头痛病因的重要性，并提出了形成表现为双层硬脑膜囊的获得性脊髓脑脊膜膨出的机制。作者建议对任何有尝试脊柱入路病史的持续性头痛进行早期脊柱 MRI 检查。如果发现获得性脊髓脑脊膜膨出，应考虑探查以完全切除囊袋。据作者所知，这是首例描述因慢性脊柱低血压导致头痛的罕见、可治疗病因的病例报告。
