Case reportEpidural blood patch in a patient with an arachnoid cyst
Introduction
Arachnoid cysts of the spine are relatively common, with an incidence of 1:600.1 They are intradural or extradural collections of cerebrospinal fluid (CSF) surrounded by arachnoid membrane. Although usually asymptomatic, they have been known to cause compression of the spinal cord. Epidural anesthesia has been used successfully in a patient with an arachnoid cyst; however, to date, the use of an epidural blood patch has not been described.2 Blood is a different substance from local anesthetic, being more dense and viscous. It would not be uncommon for a patient with an arachnoid cyst to require epidural blood patch because the diagnosis is usually established by myelography, which demonstrates an extradural defect with smooth displacement of the margin of the thecal sac.3 The posterior location of the cyst requires myelography in the supine position so that the contrast medium can fill the cyst. As myelography requires dural puncture, it is not surprising that these patients may present with postdural puncture headache (PDPHA). This case report is the first to describe the performance of an epidural blood patch in a woman with a T10 arachnoid cyst and with a postdural puncture headache. There were no adverse neurologic sequelae from the epidural blood patch.
Section snippets
Case report
A 30-year-old, 154-cm, 54-kg woman had a past medical history of migraines, gastroesophageal reflux, asthma, and fibromyalgia. Three months prior to presentation, she developed mid-back pain that radiated laterally and caudally. A magnetic resonance image (MRI) revealed a 2.5-cm hypodense oval, fluid-filled mass in the T10 area, consistent with an arachnoid cyst (Figure 1). The patient had no other neurologic symptoms. The patient received a myelogram using a 20-gauge Quincke needle. The
Discussion
Arachnoid cysts are a relatively common phenomenon. The incidence is approximately 4.6% as diagnosed by incidental finding on magnetic resonance imaging.4 The majority of these cysts are congenital in origin, arising from splitting or duplication of the arachnoid membrane and tend to occur most frequently in the thoracic spine.5 There are three types of arachnoid cysts1: spinal, extradural without spinal nerve root involvement,2 spinal, extradural with spinal nerve root involvement, and3
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Cited by (0)
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Associate Professor of Anesthesiology, Pharmacology, Obstetrics & Gynecology
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Resident in Anesthesiology
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Assistant Professor of Radiology