Obstet Gynecol Sci.  2013 Mar;56(2):130-133. 10.5468/OGS.2013.56.2.130.

Temporary homonymous hemianopsia after epidural blood patch

• Yeon H
• Shin YO
• Lee OY
• Kwon E
• Jeong EH

• KMID: 1425661
• DOI: http://doi.org/10.5468/OGS.2013.56.2.130

Abstract

We describe a case in which homonymous hemianopsia developed abruptly following an epidural blood patch procedure. The procedure was performed in a patient complaining of post-dural puncture headache after an emergency Cesarean section under spinal anesthesia. Computed tomography and magnetic resonance imaging demonstrated that air bubbles had moved from the prepontine and premedullar cisterns toward the left retrochiasmal region. The homonymous hemianopsia resolved rapidly with conservative management including oxygen, intravenous fluid, and antibiotics. We report on this case with a brief review of the related literature.

Keyword

Epidural blood patch; Homonymous hemianopsia; Pneumocephalus; Post-dural puncture headache

MeSH Terms

Anesthesia, Spinal
Anti-Bacterial Agents
Blood Patch, Epidural
Cesarean Section
Emergencies
Female
Hemianopsia
Humans
Magnetic Resonance Imaging
Oxygen
Pneumocephalus
Post-Dural Puncture Headache
Pregnancy
Anti-Bacterial Agents
Oxygen

Figure

• 

  Fig. 1 (A) Computed tomography just after the epidural blood patch procedure demonstrates a small amount of pneumocephalus at the prepontine and premedullar cisterns (arrows). Visual disturbance had not yet developed. (B) T2-weighted fast field echo imaging demonstrates a small amount of pneumocephalus in the left retrochiasmal region (arrow) while the patient was complaining of visual disturbance.

• 

  Fig. 2 Humphrey visual field test shows a complete right homonymous hemianopsia.

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