Case report
Epidural blood patch in a patient with an arachnoid cyst

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Abstract

Arachnoid cysts are relatively common occurrences, with the majority being asymptomatic. The safety of an epidural blood patch in a patient with an arachnoid cyst has not been reported. Our patient had a known thoracic arachnoid cyst and required epidural blood patch for a postdural puncture headache. Magnetic resonance imaging obtained following the epidural blood patch demonstrated no alterations of the cyst or spinal cord compression.

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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Associate Professor of Anesthesiology, Pharmacology, Obstetrics & Gynecology

Resident in Anesthesiology

Assistant Professor of Radiology

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