A 35-year-old woman with a history of migraine underwent cesarean section under spinal anesthesia using a 25G Quincke needle. On postoperative day two, she developed postdural puncture headache (PDPH) and bilateral tinnitus. Although the headache resolved with intravenous fluids and theophylline, tinnitus persisted. Audiometry revealed bilateral low-frequency sensorineural hearing loss, and cranial MRI confirmed bilateral subdural hematomas (SDHs). She was treated conservatively and discharged without neurological deficits. This case emphasizes the need to consider SDH in the differential diagnosis of PDPH, especially when atypical symptoms such as tinnitus are present. Early imaging is critical to avoid delayed diagnosis and unnecessary morbidity.
Keywords: migraine; obstetric anesthesia; postdural puncture headache; spinal anesthesia; subdural hematoma; tinnitus.
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