Post-Dural Puncture Headache with Abducens Nerve Palsy after Epidural Labor Analgesia: Successful Treatment with CT-Guided Epidural Blood Patch - A Case Report.

Introduction: Post-dural puncture headache is a well-recognized complication of neuraxial anesthesia caused by cerebrospinal fluid leakage and intracranial hypotension. Although usually self-limiting, persistent post-dural puncture headache may rarely be complicated by cranial nerve palsy. Case Presentation: We report the case of a 33-year-old postpartum woman who developed severe orthostatic headache after apparently uncomplicated epidural labor analgesia, followed by neck stiffness, auditory pressure, and horizontal diplopia due to abducens nerve palsy. Initial cranial computed tomography was unremarkable. Because symptoms persisted despite conservative therapy, magnetic resonance imaging of the brain and spine was performed and demonstrated findings consistent with intracranial hypotension and persistent spinal cerebrospinal fluid leakage. On postpartum day 15, a targeted epidural blood patch was performed under computed tomography guidance at the suspected leak site. This resulted in rapid clinical improvement, with complete resolution of symptoms within 2 weeks. Conclusion: This case highlights a rare neurological complication of post-dural puncture headache and supports the use of image-guided epidural blood patch in selected refractory cases.