Abstract
BACKGROUND: Intracranial hypotension (IH) is a secondary headache syndrome that can result from spontaneous or iatrogenic CSF leaks. Subdural hematomas (SDHs) are a particularly dangerous sequela of IH. Although epidural blood patch (EBP) is a recognized treatment for IH, its use in pediatric patients with SDH as a solitary intervention has not been reported. OBSERVATIONS: An 11-year-old male with newly diagnosed acute myeloid leukemia developed persistent, postural headaches following a lumbar puncture performed for diagnostic and therapeutic purposes. Initial imaging revealed a moderate left-sided SDH with midline shift, yet MRI of the lumbar spine failed to demonstrate an obvious CSF leak. Conservative management did not alleviate symptoms. Given the clinical picture of low CSF pressure, an EBP was administered, resulting in immediate headache improvement and subsequent radiographic evidence of SDH resolution. LESSONS: This case underscores the importance of maintaining a high index of suspicion for IH in pediatric patients with postural headaches after lumbar puncture, even when imaging is inconclusive. EBP can be a safe and effective intervention, potentially preventing further complications and clinical deterioration in this vulnerable population. https://thejns.org/doi/10.3171/CASE25254.