{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:40:04Z","timestamp":1756366804638,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,9,9]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>A postpartum female in her mid-20s presented with atypical symptoms of postdural puncture headache. However, on initial presentation, the patient reported no headache. Primary symptoms of acute, severe interscapular pain and upper extremity radiculopathy at the time of epidural placement were observed. The absence of a positional headache and the severity of pain at presentation prompted MRI analysis to establish a clinical diagnosis.<\/jats:p>\n               <jats:p>MRI findings revealed a significant cerebrospinal fluid (CSF) leak causing a mass effect on the cervicothoracic spinal cord and severe stenosis at the cauda equina. An epidural blood patch (EBP) was considered; however, it was postulated that the narrow epidural space would not be sufficient to accommodate the volume associated with an EBP. She was managed conservatively until subsequent imaging revealed CSF resorption. She received an epidural blood patch on day 7. Thereafter, her symptoms improved, allowing her to nurse her infant and be discharged home.<\/jats:p>","DOI":"10.1136\/bcr-2022-254018","type":"journal-article","created":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T11:15:14Z","timestamp":1695381314000},"page":"e254018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Delayed approach to postdural puncture headache"],"prefix":"10.1136","volume":"16","author":[{"given":"Haiyan","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Kaweah Delta Health Care District, Visalia, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Villaluz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kaweah Delta Health Care District, Visalia, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,22]]},"reference":[{"key":"2025082800194449000_16.9.e254018.1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03021057"},{"key":"2025082800194449000_16.9.e254018.2","unstructured":"Chestnut DH , Wong CA , Tsen LC , et al . Chestnut\u2019s obstetric anesthesia: principles and practice. Philadelphia: Elsevier, 2020: 730\u201344."},{"key":"2025082800194449000_16.9.e254018.3","unstructured":"Post-dural puncture headache, . 2021 Available: https:\/\/ichd-3.org\/7-headache-attributed-to-non-vascular-intracranial-disorder\/7-2-headache-attributed-to-low-cerebrospinal-fluid-pressure\/7-2-1-post-dural-puncture-headache [Accessed 20 Aug 2022]."},{"key":"2025082800194449000_16.9.e254018.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-289X(99)80007-7"},{"key":"2025082800194449000_16.9.e254018.5","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e318190e16a"},{"key":"2025082800194449000_16.9.e254018.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1993.tb06913.x"},{"key":"2025082800194449000_16.9.e254018.7","first-page":"1039","article-title":"Case of transient paralysis and paresthesia after epidural blood patch","volume":"58","author":"Kinoshita","year":"2009","journal-title":"Masui"},{"key":"2025082800194449000_16.9.e254018.8","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200206000-00035"},{"key":"2025082800194449000_16.9.e254018.9","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200108000-00012"},{"key":"2025082800194449000_16.9.e254018.10","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e318218204d"},{"key":"2025082800194449000_16.9.e254018.11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ijoa.2016.05.007","article-title":"A retrospective review of an epidural blood patch database: the incidence of epidural blood patch associated with obstetric neuraxial anesthetic techniques and the effect of blood volume on efficacy","volume":"29","author":"Booth","year":"2017","journal-title":"Int J Obstet Anesth"},{"key":"2025082800194449000_16.9.e254018.12","doi-asserted-by":"crossref","DOI":"10.1136\/rapm-2021-102473","article-title":"Sphenopalatine ganglion block for postdural puncture headache in the patient with challenging spinal anatomy","volume":"46","author":"Levin","year":"2021","journal-title":"Reg Anesth Pain Med"},{"key":"2025082800194449000_16.9.e254018.13","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000840"},{"key":"2025082800194449000_16.9.e254018.14","unstructured":"Bateman B , Cole N , Sun-Edelstein C , et al . Post dural puncture headache: clinical features, diagnosis of PDPH. In: Post T , ed. UptoDate, Waltham, MA. 2023."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-254018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:19:56Z","timestamp":1756365596000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-254018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":14,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,22]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/bcr-2022-254018"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-254018","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}