Management of Post-Dural Puncture Headache Using Autologous Epidural Blood Patch in a Patient with Acute Lymphoblastic Leukemia

摘要

We report a case of a patient in remission of acute lymphoblastic leukemia (ALL) with severe positional headaches that required an epidural blood patch (EBP) despite the higher risks of infection and introduction of blast cells to the epidural space. A 43-year-old male with a history of ALL presented with persistent positional headache after multiple intrathecal punctures. Despite initial improvement with medical treatment and bed rest, severe positional headache [consistent with post-dural puncture headache] constantly agonized the patient. EBP was performed after discussion of all of the medical teams involved. Following the procedure, the patient experienced immediate pain relief. EBP is very effective in the management of post-dural puncture headache (PDPH). Still there is risk of introducing infectious and/or malignant cells into the central nervous system. Alternatively, there are agents available that could be employed other than a patient’s own blood.