Intracranial subdural haematoma has been reported to be an exceptionally rare complication of accidental dural
puncture. An accidental lumbar dural
puncture occurred in a 36-yr-old male undergoing orthopedic knee surgery. On the morning after the operation, the patient complained of severe occipital
headache, although this was relieved with
loxoprofen and rest. This was assumed to be a
postdural puncture headache (PDPH) because it had a postural component (it was worse on sitting up). On the third day after the operation, the patient developed a severe diffuse
headache together with
nausea, which did not subside with
analgesia and
bed rest. Magnetic resonance imaging of the head showed a small
acute subdural hematoma in the bilateral temporooccipital region with no mass effect. The patient was conscious and oriented. There was no focal neurological deficit. The patient was managed conservatively with
bed rest and intravenous fluids. His condition improved without
surgical decompression and was discharged on the 40 th day after the operation. Severe and prolonged PDPH shoud be considered as a warning sign of an intracranial complication.