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.