Guirguis Maged, Jusino Eduardo, Tolba Reda, Samuel Samuel
From the *Department of Pain Management, Ochsner Clinic Foundation, New Orleans, Louisiana; and †Department of Pain Management, Anesthesiology Institute, Cleveland Clinic Foundation, New Orleans, Louisiana.
A A Case Rep. 2016 Aug 1;7(3):57-9. doi: 10.1213/XAA.0000000000000345.
Postdural puncture headache (PDPH) is a feared complication related to epidural steroid injections. We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits. Performing magnetic resonance imaging and magnetic resonance venogram should be considered early, especially in patients who fail to respond to standard interventions for PDPH.
硬膜穿刺后头痛（PDPH）是与硬膜外类固醇注射相关的一种令人担忧的并发症。我们报告了一个独特的病例，其中所有主观和客观检查结果均提示为PDPH诊断。然而，该患者经适当的保守治疗和介入治疗均无效。治疗失败促使进一步检查以确立脑静脉窦血栓形成的正确诊断。脑静脉窦血栓形成是一种罕见、难以诊断但可能致命的疾病，其临床表现不具特异性且多变，包括头痛和局灶性神经功能缺损。应尽早考虑进行磁共振成像和磁共振静脉造影，尤其是对于那些对PDPH标准干预措施无反应的患者。
