Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Case Report

It’s not always postdural puncture headache: a case report and note to the astute anesthesiologist

Nem sempre é cefaleia pós-punção dural: relato de caso e nota para o anestesiologista astuto

Ejaz Khan; Rovnat Babazade; Mohamed Ibrahim; Michelle Simon; Lindsay Juarez; Mandonca Roni; Vadhera Rakesh

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Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.


Postdural puncture headacheEpidural blood patchUnintended dural punctureEndovascular embolizationIncidental intracranial aneurysm


A punção dural é diagnosticada por uma resposta inesperadamente profunda à dose de teste de medicamento ou pelo desenvolvimento de uma cefaleia postural pós-parto. O tampão sanguíneo epidural é o padrão-ouro para o tratamento da CPPD quando o tratamento conservador falha. No entanto, dores de cabeça pós-parto podem ser resistentes a múltiplos tampões de sangue epidural. Nesses casos, processos intracranianos preexistentes devem ser considerados e descartados. Relatamos aqui o caso único de uma paciente grávida que desenvolveu cefaleia resistente no pós-parto relacionada a um aneurisma intracraniano incidental. O tratamento subsequente com embolização endovascular aliviou adequadamente seus sintomas. A consulta cirúrgica precoce e uma abordagem de equipe multidisciplinar envolvendo neurologia e neuroimagem são necessárias para o tratamento bem-sucedido de pacientes como o descrito aqui.


Cefaleia pós-punção dural; Tampão sanguíneo epidural; Punção dural não intencional; Embolização endovascular; Aneurisma intracraniano incidental


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