Korean J Anesthesiol.  2006 Jun;50(6):727-730. 10.4097/kjae.2006.50.6.727.

Differential Diagnosis of Postpartum Headache between Post-Dural Puncture Headache and Intracerebral Hemorrhage: A case report

• Lee SY
• Kwon MA
• Choi DH

• KMID: 1862253
• DOI: http://doi.org/10.4097/kjae.2006.50.6.727

Abstract

We report a patient with a postpartum headache, who was later diagnosed with an intra cerebral hemorrhage. She underwent a cesarean section under the combined spinal-epidural anesthesia, and complained of a suspicious post-dural puncture headache (PDPH) in the puerperium. The headache was partially improved with analgesics and she was discharged. The day after discharge, the headache became aggravated and she visited our labor floor for further treatment. An epidural blood patch (EBP) was performed because the headache regarded as aggravation of PDPH. However, hemiparesis and dysarthria developed 40 minutes after the EBP. Computed tomography was revealed an intracerebral hemorrhage in the right side basal ganglia. She was transferred to the neurosurgical intensive care unit. She was treated conservatively and has almost completely recovered. This case highlights the need to consider an intracranial hemorrhage, a cerebrovascular accident, nonspecific headache and PDPH when making a differential diagnosis of postpartum headache, particularly when an atypical postpartum headache is noted.

Keyword

cesarean section; combined spinal-epidural anesthesia; epidural blood patch; intracerebral hemorrhage; post-dural puncture headache

MeSH Terms

Analgesics
Anesthesia
Basal Ganglia
Blood Patch, Epidural
Cerebral Hemorrhage*
Cesarean Section
Diagnosis, Differential*
Dysarthria
Female
Headache*
Humans
Intensive Care Units
Intracranial Hemorrhages
Paresis
Post-Dural Puncture Headache*
Postpartum Period*
Pregnancy
Stroke
Analgesics