Progressive back pain due to epidural hygroma: an infrequent complication of lumbar puncture in adults

A 25-year-old woman was admitted to the emergency department with orthostatic headache, nausea and dorsal stabbing pain not relieved with decubitus. Two days prior, she had undergone lumbar puncture after consulting for malaise, fever and headache. After admission, the pain progressed to the cervical and lumbar areas, though neurological examinations were normal. A spinal MRI showed an epidural cerebrospinal fluid (CSF) collection, which extended from D1 to S1 vertebral levels, displacing the spinal cord forward and surrounding the thecal sac (figure 1). During the following 48 h, the pain worsened, such that lying prone was the only position the patient tolerated. Analgaesia with NSAIDs, opioids, corticoids and caffeine failed to provide relief, so 5 days after admission an epidural blood patch (EBP) was decided on. Twenty cubic centimetres of autologous blood were injected into the epidural space within the L4–L5 level. After the procedure, the back pain subsided …