{
  "abstract": "Background and Aims Iatrogenic dural puncture (IDP) is a recognized complication of epidural technique and often presents as post-dural puncture headache (PDPH), caused by the leak of cerebrospinal fluid (CSF). Although infrequent, excessive loss of CSF can lead to intracranial hypotension causing cranial nerves compression. Epidural blood patch (EBP) is an effective treatment for PDPH, particularly in those not responsive to conservative therapy. Diplopia resulting from sixth nerve palsy is a potential complication of intracranial hypotension following IDP and it can be completely resolved after EBP.Methods We report the case of a 23-year-old puerpera who developed a holocranial headache worsened by orthostasis, along with neck pain, 24 hours after receiving epidural analgesia for labor. The patient’s headache improved with conservative management and she was discharged 48 hours post-delivery. Sixteen days after delivery, she sought care at the emergency department with sudden horizontal binocular diplopia and limitation of right eye abduction, which had lasted for 5 days. No other neurological signs or symptoms were identified. An urgent cranial CT was performed, revealing imaging findings consistent with severe CSF hypotension. No signs of intracranial haemorrhage or thrombosis were identified. She was admitted to the Neurocritical Care Unit for further monitoring. An EBP was performed by the Anesthesiology team.Results After EP there was an immediate improvement of the clinical condition. The patient was discharged 3 days after the procedure. One month after discharge, symptoms of diplopia were completely resolved.Conclusions Awareness of post-dural puncture nerve palsy among anesthetists, obstetricians, neurologists, ophthalmologists, and general practitioners is crucial for an early diagnosis and a prompt treatment. Postpartum patients experiencing PDPH should be informed about potential complications that may arise after hospital discharge. EBP remains an effective therapeutic approach for managing complications associated with IDP.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Unidade Local Saúde Santa Maria, Lisboa, Portugal"
      ],
      "name": "Mariana Pereira"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local Saúde Santa Maria, Lisboa, Portugal"
      ],
      "name": "Sara Lourenço"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local Saúde Santa Maria, Lisboa, Portugal"
      ],
      "name": "Marco Dinis"
    },
    {
      "affiliations": [
        "Anesthesiology, Unidade Local Saúde Santa Maria, Lisboa, Portugal"
      ],
      "name": "Filipa Lança"
    }
  ],
  "title": "EP142 Epidural blood patch treatment for dural puncture-induced intracranial hypotension complicated by diplopia – a case report",
  "uid": "8aadad40-ba1d-5b39-bd3e-8ed40791742e"
}