Arachnoiditis Can Be Severe Complication of Epidural Blood Patch for Intracranial Hypotension

woman receiving epidural
The researchers aimed to report a case of arachnoiditis as a complication of epidural blood patch (EBP) procedures and to systematically review the diagnostic workup, clinical outcomes, and treatment modalities reported in the literature.

Case reports suggest arachnoiditis can be a potentially severe complication of epidural blood patch (EBP) used for the treatment of spontaneous intracranial hypotension. Because little evidence has been collected about this complication, clinicians lack a thorough understanding of how and why it appears. Findings from the researchers’ case study were highlighted in a recent edition of Headache.

This case report was based on a systematic review of case studies published in the medical literature. A total of 7 documented cases of arachnoiditis post-blood patch placement, all of which were identified using magnetic resonance imaging, were identified and included in this review. Out of these 7 cases, 6 cases of arachnoiditis following blood patch placement were a result of spinal-epidural anesthesia used for labor and delivery.

According to the case reports, the most common symptoms associated with arachnoiditis included headache, back and radicular pain, paresthesia, and motor weakness. Meningitis was also suspected in 2 cases, but workups were mostly negative for infectious processes.

The researchers who conducted the literature review found no consensus-based treatment recommendations or guidance statements on arachnoiditis post-blood patch placement. In an available case report, it was shown that intravenous methylprednisolone followed by oral prednisone taper was an effective management approach. The researchers suggest that it remains unclear whether other multimodal therapies provide benefit.

Limitations of this review study were the small number of available cases as well as the study’s overall observational nature.

Based on the available evidence, however, the investigators of the review suggest headache specialists should adopt a “healthy degree of suspicion” in situations where “patients present with severe back, perineal and lower extremity symptoms after undergoing EBP for treatment of low-pressure headache.”


Villani LA, Digre KB, Cortez MM, Bokat C, Rassner UA, Ozudogru SN. Arachnoiditis, a complication of epidural blood patch for the treatment of low-pressure headache: a case report and systematic review. Headache. 2021;61(2):244-252. doi:10.1111/head.14076