Ca. Velarde et al., Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device, REG ANES PA, 25(1), 2000, pp. 76-78
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.