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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).
Figure 1Axial noncontrast head computed tomography. There are bilateral convexity subdural
hematomas (arrows) and subdural hematoma along the interhemispheric fissure (chevrons).
The lateral ventricles partially effaced.
Figure 2Coronal noncontrast head computed tomographyt. There are bilateral convexity subdural
hematomas (arrows) and subdural hematoma along the interhemispheric fissure (chevrons).
The lateral ventricles partially effaced.
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.
Biography
Lisa M. Jin is a Physician Assistant at the Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX.
Biography
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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