Jw. Szokol et Mj. Falleroni, Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture, REG ANES PA, 24(5), 1999, pp. 470-472
Background and Objectives. Unintentional dural puncture with a Tuohy epidur
al needle during the course of an epidural anesthetic may lead to a postdur
al puncture headache and double vision. We describe a parturient that devel
oped left abducens nerve palsy after an epidural anesthetic for labor. Meth
ods. A 32-year-old female developed a postdural puncture headache 1 day aft
er an epidural anesthetic for labor. Over the next several days she began t
o complain of diplopia. Subsequent to this, she developed lateral rectus mu
scle palsy. Results. The lateral rectus palsy resolved spontaneously 8 week
s after the epidural anesthetic. Conclusions. We believe that a dural punct
ure during an attempted epidural anesthetic resulted in cerebrospinal fluid
(CSF) leakage with a consequent headache. The CSF leak caused traction on
the sixth cranial nerve resulting in lateral rectus muscle palsy. An epidur
al blood patch performed after the onset of symptoms did not acutely resolv
e the abducens nerve palsy.