A 34-year-old man presented to the emergency department for a persistent, positional headache 3 weeks after a routine lumbar puncture (LP) for the workup of multiple sclerosis. The headache started gradually approximately 1 week after the uneventful LP and consistently improved with lying flat and worsened when upright. At a previous ED visit for this headache, an epidural blood patch was considered for postdural puncture headache (PDPH); however, the anesthesia service did not think a blood patch would be better than conservative treatment, given the usual benign course and the expectation for near-term resolution of symptoms with PDPH. With the patient experiencing persistent symptoms affecting his daily activities despite home analgesics, the ED clinician ordered a noncontrast head computed tomography scan (CT) (Figures 1 and 2).
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Brian J. Ahern is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX. ORCID identifier: http://orcid.org/0000-0002-5701-3561.
Lisa M. Jin is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX.
Sean M. Sylvia is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX.
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Published by Elsevier Inc. on behalf of Emergency Nurses Association.