Case report
Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report
Željko Župan
; Department of Anesthesiology, Reanimatology and Intensive care, Medical Faculty, University of Rijeka, Rijeka, Croatia
Vlatka Sotošek Tokmadžić
; Department of Anesthesiology, Reanimatology and Intensive care, Medical Faculty, University of Rijeka, Rijeka, Croatia
Marinka Matanić-Manestar
; Department of Anesthesiology, Reanimatology and Intensive care, Medical Faculty, University of Rijeka, Rijeka, Croatia
Alan Šustić
; Department of Anesthesiology, Reanimatology and Intensive care, Medical Faculty, University of Rijeka, Rijeka, Croatia
Igor Antončić
; Department of Neurology, Medical Faculty, University of Rijeka, Rijeka Croatia
Siniša Dunatov
; Department of Neurology, Medical Faculty, University of Rijeka, Rijeka Croatia
Ivan Pavlović
; Department of Radiology, Medical Faculty, University of Rijeka, Rijeka,Croatia
Abstract
Abstract The aim of this study is to report the first case of
simultaneous appearance of cerebral venous thrombosis
(CVT) and bilateral subdural hematomas (SDHs) following
epidural analgesia for labor and delivery and to point out
the difficulty of establishing such a diagnosis in the presence
of postpartum headache. A 26-year old primigravida
with a history of epilepsy received epidural analgesia
for delivery. Three days after the uneventful spontaneous
vaginal delivery she complained about the headache. Patient
responded very well to the pain medication and oral
hydration, and the headache was relieved. Ten days after
the delivery, the headache reoccurred, and an epidural
blood patch was performed that successfully relieved
her symptom. Stronger progressive headache with nausea
reappeared two days later and the parturient was readmitted
to hospital. Urgent neuroimaging examinations
detected CVT of right the transverse sinus, ipsilateral cortical
veins, and partially occluded superior sagittal sinus, as
well as bilateral subacute/chronic SDHs. The treatment of
the patient with low molecular weight heparin and antiaggregation
therapy was effective. In this case, the diagnosis
was delayed because of atypical clinical presentation and
potentially confounding events (epidural analgesia and
assumption that it was a case of PDPH). It is important to
carefully observe patients in such conditions and promptly
conduct suitable diagnostic tests. Otherwise, unrecognized
intracranial complications and delay of appropriate
therapy could be life-threatening.
Keywords
Hrčak ID:
86025
URI
Publication date:
15.8.2012.
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