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Seizure during epidural blood patch
Abstract Number: F-53
Abstract Type: Case Report/Case Series
Introduction: Seizures caused by an epidural blood patch are extremely rare and can be a sign of an additional underlying diagnosis. We report a patient with a suspected post dural puncture headache (PDPH) who had a tonic clonic seizure during an epidural blood patch.
Case Report: A 28 year old G1P0 had an emergency lower segment caesarean section, following failed instrumental delivery, under spinal anaesthetic with 12.5mg hyperbaric bupivicaine and 300 micrograms diamorphine. She had no complaints on post operative anaesthetic follow up and was discharged on day 2. She returned on day 10 with a postural headache that had worsened over the preceding 5 days and not responded to simple analgesia. She also had photophobia and neck stiffness. Neurological examination was normal. A diagnosis of PDPH was made. The following day she underwent an epidural blood patch with 20ml of autologous blood in the left lateral position. On completion of the procedure she complained of a "fullness" in her right ear and immediately had a tonic clonic seizure which was treated with airway support and 100mg thiopentone. The seizure resolved rapidly and her GCS returned to normal after 30 minutes. She had residual left face and limb weakness. The CT scan (see figure) revealed a right frontal lobe lesion with 15mm midline shift and early hydrocephalus. She subsequently had debulking of a grade 4 glioblastoma multiforme and is having ongoing chemotherapy. Her neurological symptoms have recovered but she continues to have headaches.
Discussion: This is a late presentation for PDPH where symptoms present typically much earlier. In one large series all post dural puncture headaches presented within 72 hours. Late presentation of PDPH may warrant radiological imaging prior to epidural blood patch, to exclude other pathology. There are several case reports of seizures as a consequence of PDPH in the absence of other causes. Cases described where a seizure occurred during the epidural blood patch are rare and in all of these cases the first and only seizure occurred during the procedure. Often another diagnosis was later made.
1. Van de velde M, Schepers R, Berends N et al. Ten years of
experience with accidental dural puncture and post dural puncture
headache in a tertiary obstetric anaesthesia department. Int J Obstet
Anesth 2008 Oct;17(4):329 -35