Post-dural Puncture Headache Complicated by Subdural Hematoma in an Elderly Patient Following a Pencil-Point Spinal Needle Anesthesia: A Case Report

Spinal anesthesia using a pencil-point needle in older patients is a commonly performed procedure. Post-dural puncture headache (PDPH) is a complication that can happen following spinal anesthesia due to cerebrospinal fluid (CSF) leakage, but its incidence in elderly patients is rare. While PDPH presents with typical symptoms and resolves with conservative management, in older patients, it can happen along with intracranial subdural hematoma (SDH), a rare but potentially life-threatening complication due to the persistent CSF leak. We report a rare case of a 73-year-old woman who presented with a positional PDPH, not improving with conservative treatment after undergoing elective total hip arthroplasty under spinal anesthesia with a 25-gauge pencil-point needle. While her examinations were unremarkable except for the positional PDPH, imaging studies of her head revealed a 0.34 cm SDH that remained stable. Given the non-improving PDPH and the SDH, which remained stable under close monitoring, an epidural blood patch was performed, resulting in immediate symptom resolution without further recurrence of the PDPH or worsening of the SDH. This case highlights that both PDPH and SDH, a rare combination of complications, can happen following spinal anesthesia in elderly patients. Early recognition and timely intervention, including neuroimaging and epidural blood patch, are essential to prevent morbidity and mortality.