What is this patient's prognosis?
Diplopia usually presents 10 days postoperatively although it rarely develops after the resolution of the headache. In 2/3 of cases diplopia resolves after 1 week. One quarter of patients will have symptoms for more than 1 month. A few patients will suffer from diplopia for several years. In cases where diplopia persists for more than a year cosmetic surgical intervention (i.e. strabismus surgery) may be indicated. In the case presented, the patient's diplopia resolved 33 days after its onset.
Although the data are limited, epidural blood patch does not seem to alter the course of the cranial nerve palsy even though the injection is followed by complete resolution of the headache13. Since cranial neuropathies rarely develop before the 4th day of a continuing PDPH, some authors recommend that an epidural blood patch be performed after 4 days of continuing PDPH in an attempt to prevent cranial nerve palsies from occurring.