Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device

Background and Objectives: Complications related to cerebrospinal fluid (CS F) leak and low CSF pressure can occur following placement of an intratheca l drug delivery device. Methods: A 58-year-old man with chronic, intractable lower back pain underw ent implantation of an intrathecal drug delivery device. On the fourth post operative day, he developed a postural headache and diplopia with findings compatible with left sixth cranial nerve palsy. The headache subsequently b ecame constant and nonpostural. Cranial magnetic resonance imaging was obta ined that showed the presence of a posterior subdural intracranial hematoma . Conservative treatment for postdural puncture headache did not improve th e symptomatology Therefore, an epidural blood patch was performed that prod uced rapid improvement and eventual resolution of symptoms. Conclusions: Intrathecal catheter implantation can result in CSF loss that might not resolve promptly with conservative therapy. In this case, epidura l blood patch proved to be a safe and effective form of treatment.