Terrence L. Trentman1, Joseph M. Hoxworth2, Shimon Kusne3, A Torloni3, Naresh P. Patel4, David M. Rosenfeld
1Department of Anesthesiology, Laboratory Medicine and Pathology, and Neurosurgery, Mayo Clinic, Phoenix, AZ 85054, USA. [email protected] 2Diagnostic Radiology
3Mayo Clinic, Scottsdale, AZ
4Neurologic Surgery
Tóm tắt
In most cases of post-dural puncture headache, the positional symptoms will resolve
spontaneously within 2 weeks. Conservative therapies include oral analgesics and hydration,
bed rest, and abdominal binders. For refractory cases, an autologous epidural blood patch
remains the treatment of choice. However, in certain cases the use of autologous blood for
the blood patch may place the patient at risk for infectious or malignant contamination of the
central nervous system.
Coccidioidomycosis results from inhalation of the arthroconidia (spore) stage of the fungal
lifecycle. The most common manifestation of coccidioidomycosis is acute pulmonary
symptoms, while the most feared complication is meningitis. Immunocompromised patients
are at increased risk of fungemia; therefore, introduction of fungal elements into the central
nervous system can occur if autologous blood is used for an epidural blood patch.
We report a case of persistent dural-puncture headache in the setting of disseminated
coccidioidomycosis. An autologous blood epidural blood patch was considered but deferred
due to risk of coccidioidomycosis meningitis. Other epidural space interventions such as fibrin
glue injection or saline infusions were judged to be too imprecise or ineffective. The patient
was successfully treated with allogeneic blood donated by his wife, but only after testing of her
blood as is required for any directed blood donation. Allogeneic epidural blood patches are an
option for refractory dural puncture headaches when autologous blood may cause meningitis
or malignant seeding of the central nervous system.
Key words: Epidural blood patch, post-dural puncture headache, Coccidioidomycosis,
arthroconidia, acute pulminary symptoms
