J Korean Neurosurg Soc.  2015 Aug;58(2):144-146. 10.3340/jkns.2015.58.2.144.

Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

• Kim M
• Park KS

• KMID: 2191324
• DOI: http://doi.org/10.3340/jkns.2015.58.2.144

Abstract

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

Keyword

Headache; Chronic subdural hematoma; Epidural; Steroid; Injection

MeSH Terms

Adult
Anesthesia, Spinal
Brain
Cerebrospinal Fluid
Diagnosis
Drainage
Emergencies
Female
Headache
Headache Disorders*
Hematoma
Hematoma, Subdural, Chronic*
Humans
Intracranial Hypotension
Magnetic Resonance Imaging

Figure

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  Fig. 1 Cervical MRI, fluoroscpic imaging and brain CT findings (performed in the pain clinic). A : Sagittal T2-weighted MRI of the cervical spine showed left foraminal space narrowing of C5-6 (arrowhead). B : Axial T2-weighted MRI of the cervical spine revealed C5-6 disc herniation with exiting C6 nerve root compression (arrowhead). C : C6 epidural steroid injection using fluoroscope was performed.

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  Fig. 2 MRI findings (performed in emergency department). A : Brain MRI demonstrated a massive chronic subdural hematoma along the left convexity with mixed signals. B : There were no vascular abnormalities or enhancing lesion.

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  Fig. 3 CT findings (immediately after surgery and at the latest follow-up). A : Brain CT immediately after surgery revealed complete removal of hematoma and improvement of the midline shifting. B : Brain CT at the latest follow-up demonstrated unremarkable findings.

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