{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:48:01Z","timestamp":1761562081307},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T00:00:00Z","timestamp":1457049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec><jats:label \/><jats:p>We report a case of refractory spontaneous intracranial hypotension (<jats:styled-content style=\"fixed-case\">SIH<\/jats:styled-content>) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of <jats:styled-content style=\"fixed-case\">SIH<\/jats:styled-content> as post\u2010dural puncture headache (<jats:styled-content style=\"fixed-case\">PDPH<\/jats:styled-content>). A 56\u2010year\u2010old man received a successful appendectomy under epidural anesthesia performed at a T11\u2013T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a <jats:styled-content style=\"fixed-case\">PDPH<\/jats:styled-content> was diagnosed. However, the patient did not respond well to conservative treatment. Three months later, the first epidural blood patch was performed at the L3\u2013L4 level, however, the patient still had an orthostatic headache. Five days later, spine magnetic resonance imaging showed multiple meningeal diverticulum in the cervicothoracic junction, and computerized tomography myelography demonstrated a C5\u2013C6 spinal dural tear suggesting cerebrospinal fluid leaks. Finally, the patient was diagnosed as <jats:styled-content style=\"fixed-case\">SIH<\/jats:styled-content> and received a second epidural blood patch at the T2\u2013T3 level and responded with improvements in symptomatology. The patient was then discharged, and at a 2\u2010year follow\u2010up, he had fully recovered except for some remaining neck stiffness. This case illustrates that <jats:styled-content style=\"fixed-case\">SIH<\/jats:styled-content> was misdiagnosed as <jats:styled-content style=\"fixed-case\">PDPH<\/jats:styled-content> because of the common clinical symptoms and potentially confounding events (epidural\/spinal anesthesia and assumption that it was a case of <jats:styled-content style=\"fixed-case\">PDPH<\/jats:styled-content>). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of <jats:styled-content style=\"fixed-case\">SIH<\/jats:styled-content>, a timely epidural blood patch should be considered as soon as the diagnosis is established.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.12707","type":"journal-article","created":{"date-parts":[[2016,3,5]],"date-time":"2016-03-05T16:56:27Z","timestamp":1457196987000},"page":"677-681","source":"Crossref","is-referenced-by-count":8,"title":["Spontaneous intracranial hypotension following epidural anesthesia: a case report"],"prefix":"10.1111","volume":"60","author":[{"given":"X.","family":"An","sequence":"first","affiliation":[{"name":"Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"He","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology School of Medicine, Sir Run Run Shaw Hospital Zhejiang University, Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"X.","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology School of Medicine The First Affiliated Hospital Zhejiang University Hangzhou Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,3,4]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"290","article-title":"Neuere anschauungen zur pathophysiologie der liquorzirkulation","volume":"3","author":"Schaltenbrand G","year":"1938","journal-title":"Zentralbl Neurochir"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.19.2286"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12149"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.4045\/tidsskr.11.0832"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3325\/cmj.2012.53.379"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2014.07.007"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2007.05285.x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1054\/ijoa.2000.0825"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-196705000-00006"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2014.01.003"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.5505\/agri.2014.20591"},{"key":"e_1_2_5_13_1","unstructured":"CampbellN.Effective management of the post dural puncture headache. Anaesthesia Tutorial of the Week 2010. 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