Iatrogenic Dural Puncture-induced Abducens Nerve Palsy: Treatment with Epidural Blood Patch

Abstract

Iatrogenic dural puncture (IDP) is a known complication of epidural anesthesia. While operator experience is certainly critical in preventing inadvertent dural punctures, it can happen even in the hands of a skilled operator. Often, IDP presents as post-dural puncture headache (PDPH) without the involvement of cranial nerves; however, infrequent excessive loss of cerebrospinal fluid (CSF) can lead to intracranial hypotension causing compression of the cranial nerves, in particular, the abducens nerve. Here, we describe the case of a patient who suffered from an atypical headache with neurological sequalea from an IDP. Epidural blood patch (EBP) is an effective treatment for PDPH, especially in cases that are not responsive to conservative therapy. However, it may be the first line of defense in patients with neurological symptoms arising from low intracranial hypotension. In our case report, as well as others reported in the literature, there was a complete resolution of the neurological symptoms after the EBP was placed.