Lack of efficacy of an epidural blood patch in treating abducens nerve palsy after an unintentional dura puncture

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.