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CEREBRAL VENOUS SINUS THROMBOSIS AFTER REGIONAL ANESTHESIA IN A PATIENT WITH SEVERE PREECLAMPSIA - A DIAGNOSTIC CHALLENGE
ESRA Academy. Faísco A. Sep 8, 2016; 138419
Topic: Post-dural Puncture Headache
Dr. Ana Faísco
Dr. Ana Faísco

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Abstract
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Background and Aims:

Background: Cerebral venous sinus thrombosis is a rare condition, usually associated with coagulation disorders, inflammatory diseases, trauma, infection, pregnancy and postpartum period. The most common symptom is headache and without treatment cerebral venous thrombosis is a potentially life threatening condition. 

Aims: to report the case of a woman with severe preeclampsia who developed cerebral venous sinus thrombosis after caesarean section under spinal anesthesia.

Methods:

We review the patient´s clinical file and asked for patient consent.

Results:

Case report: A 22-year-old primigravida with severe preeclampsia underwent caesarean section under spinal anesthesia at 36 weeks of pregnancy. Twenty-four hours after C-section she complained of positional frontal and occipital headache. She was under antihypertensive therapy and was treated as post-dural puncture headache (PDPH) with bed rest, hydration, simple analgesics and caffeine. After initial relief, on postoperative day 5 she complained of increasingly headache that no longer was affected by posture. The patient was referred to Neurology and a MRI venography showed a left lateral sinus thrombosis. A blood patch was performed for pain relief and LMWH at therapeutic dose was started. The patient was discharged with clinical and imagiologic improvement.

Conclusions:

There are several causes of postpartum headache and cerebral venous sinus thrombosis is not among the most frequent. The diagnostic can be difficult especially if regional anesthesia was used or in preeclampsia cases, two of the leading causes of postpartum headache. This report emphasizes the importance of carefull differential diagnosis of postpartum headache when treating persistent PDPH.

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