BACKGROUND Traditionally, the diagnosis of post-dural puncture headache (PDPH) relied upon the patient's history regarding dural puncture and symptoms, such as orthostatic headache. However, such evidence may not always be reliable or specific. We report an unexpected diagnosis with spontaneous intracranial hypotension (SIH), which was confirmed upon examination of Magnetic Resonance (MR) images in a patient who was initially suspected to have PDPH because he had recently undergone a uncertain dural puncture. CASE PRESENTATION A 45-year-old man had undergone a thoracic epidural catheter insertion for perioperative analgesia prior to general anesthesia induction. Due to intermittent dripping of fluid while the epidural needle was being advanced, a dural puncture was suspected. The patient complained of an orthostatic headache after recovery from surgery, therefore a PDPH was suspected. MR images revealed signs of SIH: dural sinus engorgement, contrast enhancement along the neural sleeves of the left C6-7, bilateral C7-T1, T1-2, T2-3, T3-4, T4-5, and T5-6. Computed tomography-guided epidural blood patching (EBP) was performed the following day, with the patient experiencing immediate relief of the headache. CONCLUSION The benefits of radiological imaging in this case included confirming the correct diagnosis, guiding the accurate level and proper approach of EBP, distinguishing the epidural space from the intrathecal space, and ultimately increasing the likelihood of successful EBP.

中文翻译：

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影像学检查对术后体位性头痛的好处：一例报告。

背景技术传统上，硬脑膜穿刺后头痛（PDPH）的诊断依赖于患者有关硬脑膜穿刺和诸如直立性头痛之类的症状的病史。但是，此类证据可能并不总是可靠或具体的。我们报告了自发性颅内低血压（SIH）的意外诊断，该检查在对最初怀疑患有PDPH的患者进行磁共振检查（MR）图像后得到了证实，因为他最近经历了不确定的硬脑膜穿刺。病例介绍一名45岁的男性在全身麻醉之前接受了胸腔硬膜外导管插入术，用于围手术期镇痛。由于在硬膜外针前进时间歇性滴注液体，怀疑有硬膜穿刺。该患者在手术恢复后抱怨直立性头痛，因此怀疑是PDPH。MR图像显示出SIH的体征：硬膜窦充血，沿左C6-7，双侧C7-T1，T1-2，T2-3，T3-4，T4-5和T5-6的神经套管的对比度增强。第二天进行计算机断层扫描引导的硬膜外血液修补（EBP），患者立即缓解头痛。结论在这种情况下，放射影像学的好处包括确认正确的诊断，指导EBP的准确水平和正确的方法，将硬膜外腔与鞘内腔区分开，并最终增加成功进行EBP的可能性。沿左C6-7，双侧C7-T1，T1-2，T2-3，T3-4，T4-5和T5-6的神经套管进行对比增强。第二天进行计算机断层扫描引导的硬膜外血液修补（EBP），患者立即缓解头痛。结论在这种情况下，放射影像学的好处包括确认正确的诊断，指导EBP的准确水平和正确的方法，将硬膜外腔与鞘内腔区分开，并最终增加成功进行EBP的可能性。沿左C6-7，双侧C7-T1，T1-2，T2-3，T3-4，T4-5和T5-6的神经套管进行对比增强。第二天进行计算机断层扫描引导的硬膜外血液修补（EBP），患者立即缓解头痛。结论在这种情况下，放射影像学的好处包括确认正确的诊断，指导EBP的准确水平和正确的方法，将硬膜外腔与鞘内腔区分开，并最终增加成功进行EBP的可能性。