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

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


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