Introduction: Intracranial subdural fluid collections are rare complications associated with the implantation of intrathecal drug delivery systems. Not only can they can present in an atypical manner, but they can also be challenging and unfamiliar for the pain clinician who has to manage them.

Methods: All cases of intrathecal infusion pumps implanted at our institution within the past five years were reviewed for complications associated with the procedure. After obtaining IRB approval, a retrospective review of 46 patient cases was conducted. Data on complications specifically related to fluid collections was gathered. The incidence was then compared to that reported in the literature.

Results: While complications such as post-dural puncture headaches and subcutaneous seromas were commonly observed, two rare types of fluid collections were also seen. One patient who presented with a post-dural puncture headache refractory to epidural blood patches was noted to have a subdural hygroma. A second who presented with whole body weakness was found to have a subdural hematoma.

Conclusions: Given the total number of cases that were retrieved, the incidence of such rare complications in patients with intrathecal implants was difficult to assess. However, a review of the literature suggests that subdural fluid collections are extremely uncommon. There are no reported cases of hygromas and only one of a hematoma in this population. To this end, we report these two cases of intracranial subdural fluid collections in patients who presented with atypical symptoms after implantation of intrathecal pumps.