Intraventricular Blood and Pneumocephalus After Epidural Blood Patch (P1.317)

OBJECTIVE: To report a novel case of intraventricular blood and pneumocephalus following epidural blood patch. BACKGROUND: Epidural blood patch (EBP) is considered a safe and effective treatment for post-dural puncture headache (PDPH). Pneumocephalus due to unintentional introduction of air into the subarachnoid space is a rare but recognized complication. We report a novel case of intraventricular blood and pneumocephalus following EBP. DESIGN/METHODS: Case report and literature review. RESULTS: A 42 year-old woman with a history of HIV presented with headache and photophobia. Lumbar puncture was performed and normal. She was discharged, but developed a persistent orthostatic headache one day later and returned for evaluation. She was diagnosed with PDPH and an EBP was done. Immediately after the procedure, she developed a severe right-sided headache. CT of the head showed abundant pneumocephalus and hyperdense fluid in the lateral ventricles, most consistent with blood. Crowding of the posterior fossa was seen, suggestive of intracranial hypotension. MRI of the brain showed scattered T1 & T2 hyperintense foci in the subarachnoid space, also consistent with air. MRI of the lumbar spine showed epidural air in the dorsal lumbar sac from L3 to L5. She was treated with analgesics and symptoms resolved shortly. Follow-up CT 2 weeks later showed resolution of the abnormal findings. CONCLUSIONS: EBP is generally a safe and effective treatment for PDPH. Pain around the injection site and in the legs is the most common side effect. Rarely, air may pass inadvertently into the subarachnoid space during EBP and migrate cephalad, resulting in severe headache due to pneumocephalus. This is the first published report of intraventricular blood coupled with pneumocephalus to be seen observed after EBP. It is not known what the incidence or long term neurologic sequelae are. In our patient, both symptoms and radiographic findings were self-limited. Study Supported by: Disclosure: Dr. Chen has nothing to disclose. Dr. Hillen has nothing to disclose.