Epidural blood patch in leukemia patient: a case report

Pain Med. 2014 Aug;15(8):1343-5. doi: 10.1111/pme.12470. Epub 2014 Jul 7.


Objective: We present a case of a patient with acute lymphoblastic leukemia (ALL) undergoing an epidural blood patch (EBP) for post-puncture dural headaches despite the risks of spreading cancer cells to the epidural space.

Setting and patient: A 46-year-old male with a history of adult T-cell ALL presented with persistent positional headache and neutropenic fever 2 weeks after receiving multiple intrathecal methotrexate treatments. His symptoms were consistent with post-dural puncture headache. The patient underwent an EBP and experienced complete pain relief following the procedure. He had no evidence of central nervous system involvement of ALL on his last evaluation 3 months following the blood patch.

Conclusion: Post-dural puncture headache due to intrathecal administration of chemotherapy agents becomes increasingly recognized, and there are an increasing number of requests to anesthesiologists for EBP. A major concern in the patient population with hematological malignancies is the possibility of neuroaxial seeding of malignancies. Therein, flow cytometry was implemented to screen for blast cells in the circulating blood. Careful analysis and minimization of this potential risk is required to ensure the safety of the EBP in this specific patient population.

Keywords: Chemotherapy; Dural Puncture Headache; Epidural Blood Patch.

Publication types

  • Case Reports

MeSH terms

  • Antimetabolites, Antineoplastic / administration & dosage
  • Blood Patch, Epidural*
  • Flow Cytometry
  • Humans
  • Injections, Spinal / adverse effects*
  • Male
  • Methotrexate / administration & dosage
  • Middle Aged
  • Post-Dural Puncture Headache / surgery*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*


  • Antimetabolites, Antineoplastic
  • Methotrexate