Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.003
Brazilian Journal of Anesthesiology
Case Report

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

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

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Abstract

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.

Keywords

Postdural puncture headacheEpidural blood patchUnintended dural punctureEndovascular embolizationIncidental intracranial aneurysm

References

1 C.L. Gurudatt Unintentional dural puncture and postdural puncture headache – can this headache of the patient as well as the anaesthesiologist be prevented? Indian J Anaesth., 58 (2014), pp. 385-387

2 R.G. Davies, C.J. Laxton, F.A. Donald Unrecognised dural punctures Int J Obstet Anesth., 12 (2003), pp. 142-143

3 J.S. Sprigge, S.J. Harper Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital Anaesth Rep., 63 (2008), pp. 36-43

4 V. Safa-Tisseront, F. Thormann, P. Malassiné, M. Henry, B. Riou, P. Coriat, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache Anesthesiology., 95 (2001), pp. 334-339

5 Y.W. Kim, D. Neal, B.L. Hoh Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture Neurosurgery., 72 (2013), pp. 143-149 discussion 150

6 G.J. Rinkel Natural history, epidemiology and screening of unruptured intracranial aneurysms J Neuroradiol., 35 (2008), pp. 99-103

7 H.J. Priebe Aneurysmal subarachnoid haemorrhage and the anaesthetist Br J Anaesth., 99 (2007), pp. 102-118

8 L.A. Nelson Ruptured cerebral aneurysm in the pregnant patient Int Anesthesiol Clin., 43 (2005), pp. 81-97

9 R.R. Al-Metwali Epidural morphine injections for prevention of post dural puncture headache Anaesth Rep., 63 (2008), pp. 847-850

10 E.N. Grant, J. Wang, B. Gelpi, A. Wortman, W. Tao Diagnosing and managing peripartum headache Proc (Bayl Univ Med Cent)., 28 (2015), pp. 463-465

11 S. Reddi, V. Honchar, M.S. Robbins Pneumocephalus associated with epidural and spinal anesthesia for labor Neurol Clin Pract., 5 (2015), pp. 376-382

12 E. Stanhope, L. Foulds, G. Sayed, U. Goldmann Diagnosing causes of headache within the postpartum period J Obstet Gynaecol., 38 (2018), p. 728

13 D.K. Turnbull, D.B. Shepherd Post-dural puncture headache: pathogenesis, prevention and treatment Br J Anaesth., 91 (2003), pp. 718-729

14 Yao, F. Yao and Artusio’s Anesthesiology. 6th edition. 2008-625-629.
 

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