Introduction
In a study conducted in Korea, it was found that only 0.8% of 2669
participants had an anatomical variation wherein the dural sac extended
below S3, while 1.6% had pathological conditions like perineural cysts
and meningoceles.[1] The incidence of post-dural
puncture headache (PDPH) after caudal epidural block due to these
anatomical abnormalities was low and its occurrence difficult to
predict.[2] Epidural blood patch (EBP), considered
a gold standard treatment in PDPH, can lead to improvement of symptoms
in more than 90% of cases.[3] However, EBP cannot
be performed on PDPH patients who do not respond to conservative
management due to possible complications.
We report our experience in diagnosing rare tethered cord syndrome
(TCS), which could cause PDPH, secondary to CSF leakage through an MRI.
The MRI was performed to investigate the reason for subcutaneous
cerebrospinal fluid (CSF) collection suspected by physical examinations
and bedside sonography. PDPH accompanied by TCS was successfully
resolved after using an abdominal binder, as reinforced conservative
management, for a week.