803 - Rebound Intracranial Hypertension as a Potential Complication Following Epidural Blood Patch for Post-Dural Puncture Headache: A Case Report

Case Diagnosis: Rebound headache after epidural blood patch.

Case Description: A 43-year-old female with history of chronic radicular low back pain presented for L5-S1 interlaminar epidural steroid injection. Post-procedure she developed persistent occipital headaches which did not improve with oral anti-inflammatories, caffeine or rest. The headache was attributed to post-dural puncture and subsequently underwent an epidural blood patch (EBP). Following EBP, the headache initially improved. However, within 48 hours the headache returned now in the frontal/periorbital region with associated tinnitus and blurry vision. Blurry vision self-resolved. Given the return and change in headache, rebound intracranial hypertension (RIH) was suspected. MRI brain and lumbar spine were ordered to rule out other causes of headache. Both MRIs were negative for acute pathology. At follow-up (15 days post-EBP) headaches had improved and no longer impacting daily function. Treatment options were discussed including lumbar puncture, acetazolamide, and conservative monitoring. The patient opted for conservative management. She will be followed closely for continued symptom monitoring.

Discussions: The return of headaches following an EBP raised suspicion for the rare complication of RIH. The manifestation of symptoms, including tinnitus, visual disturbances, and change in headache characteristics strongly suggested raised intracranial pressure. The delayed onset of symptoms aligns with known complications associated with overcorrection or inadvertent over-filling of the epidural space, leading to subsequent intracranial hypertension.

Conclusions: This case highlights the potential complication of rebound intracranial hypertension following EBP. While symptoms are typically mild and resolve on their own, there are cases of severe and persistent symptoms. Careful consideration should be given to the possibility of RIH in patients presenting with a return of headaches post-EBP. Understanding the clinical presentation of RIH allows for early detection and tailored interventions to manage elevated intracranial pressure and associated symptoms effectively.