Background: Traditionally, the diagnosis of post-dural puncture headache (PDPH) relied upon the patientâ??s history\nregarding dural puncture and symptoms, such as orthostatic headache. However, such evidence may not always be\nreliable or specific. We report an unexpected diagnosis with spontaneous intracranial hypotension (SIH), which was\nconfirmed upon examination of Magnetic Resonance (MR) images in a patient who was initially suspected to have\nPDPH because he had recently undergone a uncertain dural puncture.\nCase presentation: A 45-year-old man had undergone a thoracic epidural catheter insertion for perioperative\nanalgesia prior to general anesthesia induction. Due to intermittent dripping of fluid while the epidural needle was\nbeing advanced, a dural puncture was suspected. The patient complained of an orthostatic headache after recovery\nfrom surgery, therefore a PDPH was suspected. MR images revealed signs of SIH: dural sinus engorgement, contrast\nenhancement along the neural sleeves of the left C6-7, bilateral C7-T1, T1-2, T2-3, T3-4, T4-5, and T5-6.\nComputed tomography-guided epidural blood patching (EBP) was performed the following day, with the patient\nexperiencing immediate relief of the headache.\nConclusion: The benefits of radiological imaging in this case included confirming the correct diagnosis, guiding\nthe accurate level and proper approach of EBP, distinguishing the epidural space from the intrathecal space, and\nultimately increasing the likelihood of successful EBP.
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