Nepomuceno Roman, Herd Anthony
University of Manitoba, Winnipeg, Manitoba, Canada.
J Emerg Med. 2013 Feb;44(2):e227-30. doi: 10.1016/j.jemermed.2012.06.025. Epub 2012 Sep 5.
Post-dural puncture headache (PDPH) is typically a benign complication of dural puncture that is clinically diagnosed. It commonly presents as a throbbing and positional headache that occurs 24-48 h after dural puncture. Subdural hematomas, if unrecognized, may occur as a rare and life-threatening complication of dural puncture.
We aim to describe the clinical features and sequelae of a rare complication that may result as a consequence of inadvertent dural puncture that, if unrecognized, has the potential to become a life-threatening complication from a common procedure.
We report the case of a previously healthy 17-year-old primigravida female who initially presented 4 days postpartum with clinical features and imaging studies consistent with PDPH. The patient's symptoms were unremitting, and within 4 weeks, she developed bilateral subdural hematoma. With prompt recognition and diagnosis, she was treated with conservative medical management and subsequently improved on follow-up.
Patients with unremitting PDPH should prompt the clinician to suspect the development of subdural hematoma as a potential life-threatening complication of an otherwise benign condition.
硬膜穿刺后头痛（PDPH）通常是硬膜穿刺的一种良性并发症，可通过临床诊断。其通常表现为搏动性和体位性头痛，在硬膜穿刺后24 - 48小时出现。硬膜下血肿若未被识别，可能作为硬膜穿刺罕见且危及生命的并发症出现。
我们旨在描述一种罕见并发症的临床特征和后遗症，该并发症可能因硬膜意外穿刺导致，若未被识别，有可能从一个常见操作演变为危及生命的并发症。
我们报告一例先前健康的17岁初产妇，产后4天初诊，其临床特征及影像学检查结果符合PDPH。患者症状持续不缓解，4周内双侧发生硬膜下血肿。经及时识别和诊断，给予保守药物治疗，随后随访病情好转。
持续存在PDPH的患者应促使临床医生怀疑硬膜下血肿的发生，这是一种原本良性情况可能出现的潜在危及生命的并发症。
