Research Information System
JOURNAL OF NEUROLOGICAL SCIENCES-TURKISH, vol.30, no.2, pp.427-432, 2013 (SCI-Expanded)
Epidural steroid administration is a frequently used method for the treatment of chronic back pain. Major complications range from transient headache and pain on injection site to hemorrhage. Dural puncture occured while injecting the second epidural steroid dosage to a 24-year-old male patient with lumbar disc hernia. After 6 days, the patient was hospitalized due to persistent headache; he was discharged with appropriate recommendations when his headache resolved after 6 days of treatment. However, he presented to the pain clinic with headache, nausea and vomiting on the 13. day of discharge (i.e. 25 days after the second epidural injection). MR imaging revealed hemorrhagic subdural effusion and diffuse dural thickening. Hematoma was evacuated surgically and the patient was discharged on the 5. postoperative day without neurological deficits. Eventhough the first explanation that comes to our mind is postdural puncture for headache occuring after epidural applications, it should not be forgotten that one might encounter rare life-threatening complications like subdural hematomas. In our patient who did not have neurological deficits and was thought to have postdural puncture headache, the change and increase in symptoms led us to consider intracranial hemorrhage. Our patient was diagnosed in the subacute period, treated appropriately and discharged without neurological deficits. To our knowledge, this the first case reported in the literature for bilateral subdural hematoma occuring after epidural steroid injection. Patients presenting with headache after dural puncture should be followed carefully for intracranial hemorrhage, and further examinations carried out when judged necessary.