硬膜穿刺後頭痛を疑い治療を行ったが低ナトリウム血症が判明した症例

Translated title of the contribution: Hyponatremia as a Cause of Postoperative Headache after Epidural Anesthesia

杉部 清佳, 池田 水子, 宮崎 良平, 東 みどり子, 神田橋 忠, 外 須美夫

Research output: Contribution to journalArticle

Abstract

<p>Post-dural puncture headache(PDPH)is a complication of epidural anesthesia. We report a patient who developed headache after epidural catheter removal, which was initially treated as PDPH, but was followed by decreased level of consciousness. Blood tests revealed severe hyponatremia.</p><p>A 61-year-old man underwent thoracoscopic right lower lung lobectomy under general anesthesia with epidural anesthesia. On 2 POD, after epidural catheter removal, he complained of headache. We started conservative therapy as for PDPH with bed rest, fluid therapy and NSAIDs, but his symptom did not improve and he subsequently developed decreased level of consciousness on 10 POD. There were no significant signs in CT scan but serum sodium decreased to 113 mmol/L. Intravenous infusion of 3% hypertonic saline was started. Two days after treatment, his symptom was relieved with serum sodium at 125 mmol/L. Water restriction was continued until full recovery on 16 POD. Laboratory data suggested SIADH and hypoadrenalism. The patient started taking steroids and was discharged home without any complications on 26 POD.</p><p>PDPH is relatively common, but the lack of response to treatment should raise suspicion of differential diagnosis. Hyponatremia may induce headache, so it should be considered in the differential diagnosis of PDPH.</p>
Translated title of the contributionHyponatremia as a Cause of Postoperative Headache after Epidural Anesthesia
Original languageJapanese
Pages (from-to)600-605
Number of pages6
Journal日本臨床麻酔学会誌
Volume37
Issue number5
DOIs
Publication statusPublished - 2017

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