Thunderclap Headache Caused by an Inadvertent Epidural Puncture During Oxygen-ozone Therapy for Patient with Cervical Disc Herniation

• Published in: Chinese medical journal 2016-02, Vol.129 (4), p.498-499
• Main Authors: Liu, Hui, Wang, Yong, An, Jian-Xiong, Williams, John, Cope, Doris
• Format: Article
• Language: English
• Subjects: Anesthesiology; Aviation; Colleges & universities; Correspondence; Critical care; Epidural Space; Female; Headache Disorders, Primary - etiology; Headaches; Heart rate; Humans; Intervertebral Disc Displacement - drug therapy; Medicine; Middle Aged; Oxygen - administration & dosage; Ozone - administration & dosage; Pain; Physicians; Spinal Puncture - adverse effects; 头痛; 患者; 椎间盘突出症; 治疗; 硬膜; 穿刺; 臭氧浓度; 血氧饱和度
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.176080

To the Editor： A 54-year-old woman with no significant history of a headache or hypertension underwent epidural oxygen-ozone injection at a concentration of 30ug/ml （3 ml） for cervical disc herniation at cervical vertebra （C6-C7） level. Throughout the procedure, the routine monitorings of blood pressure, heart rate, and blood oxygen saturation were perfomled. One minute following the end of the injection, tile patient developed a high-intensity headache mimicking symptoms of a ruptured cerebral aneurysm. The patient described the location of a headache as present in the l~ontoparietal and occipital areas accompanied by nausea and vomiting. The presumptive diagnosis of inadvertent epidural puncture was made. The patient was immediately treated oxygen therapy and bed rest. Monitoring showed vital signs of blood pressure （149/83 mmHg）, heart rate （86 beats/min）, pulse oxygen saturation （SpO2, 96%）, blood sugar （6.3 mmol/L）, and body temperature （36.6℃）. Subsequently, metoclopramide 10 mg and midazolam 1 mg were injected intravenously.