Epidural Headache Causing Subdural Hematoma

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Epidural Headache Causing Life Threatening Subdural Hematoma. Norman's Story

In the Medlink-Neurology Clinical Summary for Headache associated with low CSF pressure, under "Clinical Manifestations" one of the things it says is:

"Of note, a change in headache pattern should alert the physician to the possibility of development of complications, such as subdural hematoma or cerebral venous thrombosis (Lai et al 2007b; Schievink and Maya 2008)."

The cerebrospinal fluid (CSF) cushions the brain and nerves in the spine. A puncture in the dura surrounding the spine (which happens about 1% of the time in epidural analgesia) can result in a leak of this fluid. Low CSF stretches and distorts sensitive brain structures that normally float on this fluid cushion and can cause headaches. In rare but dangerous cases low CSF can cause bleeding in the brain.

This is what happened to me, and my doctors were unaware of this danger. I received epidural analgesia for abdominal surgery, and developed epidural headaches a couple of days later and was sent home and told to wait them out with caffein/painkillers. After about 10 days the nature of the headaches changed -- I now had them when I first lay down, rather than when I stood up for awhile. A few days later I had brief stroke-like symptoms (TIA). The anesthesiologist dismissed these as having nothing to do with the epidural and told me to see my primary care doctor. He in turn thought it unlikely my symptoms were neurological in origin. I had a car accident on the way home from seeing him, because I became confused about which pedal was the brake.

I went to emergency the next day and MRI confirmed I had a cerebral venous thrombosis (blood clot in my brain), which fortunately resolved by itself. I was on blood thinners for three months and then MRI confirmed the clot was gone. The expert neurologist at my last visit commented that I'd been lucky -- about 1/3 of people who have bleeding in the brain where mine was die.

This was a rare complication (bleeding in the brain) of a rare complication (epidural headache), but my doctors' ignorance of something that's in the standard neurology summary for CSF leak caused me a lot of unnecessary difficulty and put my life in jeopardy.

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