Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Headache. 2023 Jul-Aug;63(7):981-983. doi: 10.1111/head.14584. Epub 2023 Jun 26.
A 24-year-old woman experienced a postdural puncture headache following a labor epidural, recovered following bedrest, and was then without headache for 12 years. She then experienced sudden onset of daily, holocephalic headache persisting for 6 years prior to presentation. Pain reduced with prolonged recumbency. MRI brain, MRI myelography, and later bilateral decubitus digital subtraction myelography showed no cerebrospinal fluid (CSF) leak or CSF venous fistula, and normal opening pressure. Review of an initial noncontrast MRI myelogram revealed a subcentimeter dural outpouching at L3-L4, suspicious for a posttraumatic arachnoid bleb. Targeted epidural fibrin patch at the bleb resulted in profound but temporary symptom relief, and the patient was offered surgical repair. Intraoperatively, an arachnoid bleb was discovered and repaired followed by remission of headache. We report that a distant dural puncture can play a causative role in the long delayed onset of new daily persistent headache.
一位 24 岁女性在分娩硬膜外麻醉后出现了穿刺后头痛，卧床休息后恢复，此后 12 年内没有头痛。随后，她突然出现了每天持续的全头痛，在就诊前持续了 6 年。疼痛在长时间卧床时减轻。脑部 MRI、脊髓 MRI 造影，以及后来的双侧卧位数字减影脊髓造影显示没有脑脊液（CSF）漏或 CSF 静脉瘘，以及正常的开放压力。对初始非对比脊髓 MRI 造影的回顾显示，在 L3-L4 处有一个亚厘米的硬脑膜膨出，疑似创伤后蛛网膜囊肿。在囊肿处进行靶向硬膜外纤维蛋白贴补治疗后，症状得到了显著但暂时的缓解，随后为患者提供了手术修复。术中发现并修复了蛛网膜囊肿，头痛随之缓解。我们报告称，远处的硬脑膜穿刺可能在新的每日持续性头痛的长时间延迟发作中起因果作用。
