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Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache

Title
Case report: postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache
Author
조상윤
Keywords
Cerebral venous thrombosis; Postdural puncture headache; Pregnancy
Issue Date
2020-04
Publisher
BMC
Citation
BMC ANESTHESIOLOGY, v. 20, no. 1, article no. 80
Abstract
Background Cerebral venous thrombosis can be a fatal complication of the postpartum period. Pregnancy is known to be a risk factor for thromboembolism in itself. Case presentation A normal spontaneous vaginal delivery was planned for a 20-year-old primigravida patient with patient-controlled epidural analgesia. Next morning, the patient complained of an occipital headache. An epidural blood patch was performed for diagnostic and therapeutic purpose with 10 ml of autologous blood. That night, she had an episode of seizures. Endotracheal intubation was done to secure the airway. She was transferred to an intensive care unit. Brain CT angiography and MRI showed superior sagittal sinus thrombosis with acute infarct and mild subarachnoid haemorrhage. For cerebral venous thrombosis treatment, heparin was injected and for intracranial pressure control, a hypertonic solution was injected. Despite this medical treatment, intracranial pressure continued to rise. The next day, her mental state changed to stupor. Emergency decompressive craniectomy was performed. Her mental state improved rapidly after surgery. A week later, she was transferred to a general ward. Her health recovered and she was discharged. Conclusions We experienced postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. We hope that this case report would be helpful in situation which a postpartum young woman complains severe headache in spite of management for headache including autologous epidural blood patch.
URI
https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-020-00992-1https://repository.hanyang.ac.kr/handle/20.500.11754/165862
ISSN
1471-2253
DOI
10.1186/s12871-020-00992-1
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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