Partownavid P, Wang L, Alaei S, Rahman S
Department of Anaesthesiology David Geffen School of Medicine University of California Los Angeles CA USA.
Anaesth Rep. 2021 Jul 23;9(2):e12127. doi: 10.1002/anr3.12127. eCollection 2021 Jul-Dec.
Post-dural puncture headache is a consequence of cerebrospinal fluid loss, leading to reduced intracranial pressure. Its classical symptoms include a frontal-occipital headache which is worse on standing, neck stiffness, nausea, hearing loss and photophobia. In this report, we describe an atypical presentation of post-dural puncture headache in a 72-year-old woman following an endovascular repair of an aortic aneurysm, before which a lumbar spinal drain was placed to reduce the risk of spinal cord ischemia. Following drain removal, the patient developed hypoactive delirium, challenges with both depth perception and fine motor skills and a mild headache. An epidural blood patch was performed, which resulted in the complete resolution of her symptoms. This case highlights an atypical presentation of post-dural puncture headache in an older patient, in whom the major symptoms were cognitive. Cerebrospinal fluid leakage should be considered as a cause of postoperative delirium in patients who have undergone neuraxial anaesthesia.
硬膜穿刺后头痛是脑脊液流失的结果，导致颅内压降低。其典型症状包括站立时加重的额枕部头痛、颈部僵硬、恶心、听力丧失和畏光。在本报告中，我们描述了一名72岁女性在主动脉瘤血管内修复术后出现的硬膜穿刺后头痛的非典型表现，在此之前放置了腰段脊髓引流管以降低脊髓缺血风险。引流管拔除后，患者出现了谵妄、深度知觉和精细运动技能方面的问题以及轻度头痛。进行了硬膜外血贴治疗，症状完全缓解。该病例突出了老年患者硬膜穿刺后头痛的非典型表现，其主要症状为认知方面的。对于接受了椎管内麻醉的患者，脑脊液漏应被视为术后谵妄的一个原因。
