Chronic adhesive arachnoiditis after repeat epidural blood patch

• Chronic adhesive arachnoiditis after a repeat epidural blood patch for post dural puncture headache is presented.
• The use of repeat high volume epidural blood patch may have been a factor causing arachnoiditis.
• Two years after repeat epidural blood patch the patient’s neurological condition is still impaired.

Epidural blood patching is an effective treatment for postdural puncture headache but has potential risks. Arachnoiditis is a very rare disabling condition and few cases have been described following an epidural blood patch. We present a case of chronic adhesive arachnoiditis in a parturient treated with a repeat epidural blood patch. A healthy 29-year-old woman had an accidental dural puncture following epidural insertion during labour. Initial treatment of postdural puncture headache with an epidural blood patch was ineffective and was therefore repeated. She gradually developed severe neurological symptoms consistent with arachnoiditis confirmed with magnetic resonance imaging. Despite intensive multimodal treatment with analgesics and physiotherapy, her neurological condition remains unresolved two years later. This serious but rare complication should encourage caution when treating parturients with postdural puncture headache with a repeat epidural blood patch.