Abstract
A 32-year-old parturient was scheduled for an elective cesarean section with combined spinal and epidural anesthesia. Accidental dural puncture with a 17G epidural needle occurred and she underwent the cesarean section with only spinal anesthesia. The following day, she complained of a severe orthostatic headache, which was strongly suspected to be a postdural puncture headache (PDPH). Plain spinal MRI showed accumulation of epidural fluid, which was considered to be a cerebrospinal leakage. A brain MRI showed bilateral subdural hematoma. She received an epidural blood patch on the 12th postoperative day. The symptoms of PDPH and intracranial hematoma improved gradually. She was discharged three weeks after the operation with no neurological deficits. One month later, a transient headache and intracranial hematoma developed, but a spinal MRI showed no cerebrospinal leakage. Her headache and intracranial hematoma improved without additional treatment within two months. Continuous leakage from the lumbar subarachnoid space can lead to an intracranial subdural hematoma and a spinal MRI may be beneficial for evaluating cerebrospinal fluid leaks.
