{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T15:57:17Z","timestamp":1774367837877,"version":"3.50.1"},"reference-count":0,"publisher":"American Society of Interventional Pain Physicians","issue":"3;5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Phys"],"published-print":{"date-parts":[[2010,5,14]]},"abstract":"<jats:p>Introduction: Postdural puncture headache (PDPH) is a known complication of diagnostic\nlumbar puncture. Multiple factors including needle size, type, and needle bevel orientation, have\nbeen postulated to contribute to the development of PDPH. The presentation of PDPH tends\nto have classic symptoms that include a postural headache, nausea, vomiting, tinnitus, and\nocular disturbances. Conservative treatment measures include bed rest, intravenous hydration\nor caffeine, and analgesics. Resistant cases might require an epidural blood patch (EBP).\nThough complications are rare, cases of immediate post-procedural pain and subdural epidural\nhematoma have been reported. Here we present a case of PDPH treated with sequential EBPs\nthat resulted in delayed radicular pain.\nCase Report: A 29-year-old female presented to the emergency room with a severe frontal\nheadache of several days duration. She underwent a diagnostic lumbar puncture as a part of\nher work-up. Then, 24-48 hours later she developed a severe postural headache unresponsive to\nconservative care. Two days later she underwent an epidural blood patch with 20 mL of autologous\nblood. Her symptoms did not abate, prompting a repeat EBP within 24 hours with an additional\n20 mL of autologous blood. Five days later the patient began experiencing muscle spasms and\nradicular pain in the buttocks and left posterior leg that radiated to her posterior calf. The patient\nwas initially started on pregabalin 25mg 3 times daily, and underwent a gadonlinum-enhanced\nMRI of the lumbar spine. She followed up 5 days later with unchanged symptoms and a negative\nMRI. She was then started on a methylprednisolone taper and continued the pregabalin. At the\n10-day follow-up, there was 90% resolution of symptoms and a pain intensity of 1\/10 on NRS. At\nthis time she is continuing the pregabalin with plans to discontinue medication.\nDiscussion: Although EBP is typically a safe procedure, complications might occur. An\ninflammatory response, secondary to the injection of blood, or mechanical compression, due\nto the total volume of blood injection, are highlighted as possible causative agents in the\ndevelopment of this complication. The role of fluoroscopic imaging, particularly in patients who\nhave failed an initial EBP, must also be examined. Given the rates of false loss of resistance (17-\n30%) reported in the literature, the use of real-time imaging to ensure proper needle placement\nand subsequent injectate spread should be considered.\nKey words: Blood patch, epidural, radiculopathy, postdural puncture headache, complications,\nfluoroscopy, epidural<\/jats:p>","DOI":"10.36076\/ppj.2010\/13\/257","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T20:30:17Z","timestamp":1616531417000},"page":"257-262","source":"Crossref","is-referenced-by-count":32,"title":["Delayed Radicular Pain Following Two Large\nVolume Epidural Blood Patches for Post-Lumbar\nPuncture Headache: A Case Report"],"prefix":"10.36076","volume":"3;13","author":[{"suffix":"MD, MPH","given":"Mehul J.","family":"Desai","sequence":"first","affiliation":[{"name":"George Washington University Hospital, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"21814","published-online":{"date-parts":[[2010,5,15]]},"container-title":["Pain Physician"],"original-title":[],"language":"en","deposited":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T20:30:19Z","timestamp":1616531419000},"score":1,"resource":{"primary":{"URL":"https:\/\/painphysicianjournal.com\/current\/pdf?article=MTM0OQ%3D%3D&journal=55"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,5,14]]},"references-count":0,"issue-title":["May 2010"],"journal-issue":{"issue":"3;5","published-online":{"date-parts":[[2010,5,5]]},"published-print":{"date-parts":[[2010,5,4]]}},"URL":"https:\/\/doi.org\/10.36076\/ppj.2010\/13\/257","archive":["Internet Archive","Internet Archive"],"relation":{},"ISSN":["2150-1149","1533-3159"],"issn-type":[{"value":"2150-1149","type":"electronic"},{"value":"1533-3159","type":"print"}],"subject":[],"published":{"date-parts":[[2010,5,14]]}}}