Orgasmic dural tear: an unusual delayed presentation of postural headache following lumbar discectomy.

A 28-year-old woman presented with a severe unremitting frontal postural headache associated with photophobia. This started immediately after standing following reaching orgasm during sexual intercourse. Fifty-two days previously, the patient underwent bilateral L4-L5 decompression laminotomies and a left L4-L5 discectomy for excision of a large herniated intervertebral disc. Subarachnoid haemorrhage was excluded with a CT scan. Brain and lumbar MRI showed enhancement of the pachymeninges and a cerebrospinal fluid (CSF) leak into the deep soft tissue planes. Conservative treatment for 5 days failed to alleviate the patient's symptoms. An exploration and repair of a dural tear was performed. Subsequently, the headache subsided but the patient developed a low-grade infection requiring 12 weeks of antibiotics. Six months later the patient was asymptomatic. This is the first case report of a delayed presentation of a dural tear occurring during sexual intercourse following lumbar surgery.

Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2.

A 54-year-old Caucasian woman presented with a 6 week history of periscapular pain and a T1 radiculopathy associated with Horner's syndrome. MRI of her cervicothoracic spine revealed an intervertebral disc herniation at the level of T1-2. During investigation she experienced some improvement in her symptoms and a conservative approach was pursued. At 6 months her pain and radiculopathy had resolved, and there was mild residual ptosis.