Diplopia: a complication of dural puncture.

DIPLOPIA or extraocular muscle paralysis (EOMP) after dural puncture has been reported occasionally, primarily in the neurology and ophthalmology literature. Because there seems to be a window period before diplopia manifests after dural puncture, the patient and physician may not always believe that the symptom is secondary to dural puncture, particularly when it occurs after resolution of a post–dural puncture headache (PDPH). Diplopia can be so disturbing that it may prompt the patient to seek immediate medical attention. Many patients have been referred to neurologists or ophthalmologists for extensive investigation. Therefore, it is not surprising that anesthesiologists may be unaware of this complication. The first case of diplopia after dural puncture was reported by Quincke more than 100 yr ago. Nonetheless, the latest major anesthesia textbooks describe little, if any, of this complication. It is important that anesthesiologists, emergency physicians, neurologists, and ophthalmologists recognize and communicate findings related to this distressing complication.