Incidental finding of an arachnoid cyst in a patient presenting with features of postural headache after spinal anesthesia.

CC Postural headache can be caused by several underlying etiologies [1], therefore, when postural headache develops after spinal anesthesia, differential diagnosis and evaluation are imperative, despite a clear history of dural puncture and prominent features of headache with postural changes, indicating postdural puncture headache (PDPH). In this report, we address an incidental finding of an arachnoid cyst in a previously healthy, asymptomatic patient who experienced postural headache after spinal anesthesia for urologic surgery. A 26-year-old male (180 cm, 68.8 kg) was admitted for left varicocelectomy. He had not had any previous history of headache, neurologic signs or back pain, and his preoperative evaluation was normal. Thus spinal anesthesia was performed. For spinal anesthesia, a 25 gauge whitacre spinal needle was inserted at L3-4 via midline approach. The intrathecal space was approached at an initial attempt, and 0.5% bupivacaine (heavy Marcaine Ⓡ , Astra Zeneca, Luton, UK) 14 mg with fentanyl 15