Minai Fauzia N, Hasan Syeda Fauzia, Sheerani Mughis
Department of Anaesthesia, The Aga Khan University, Karachi.
J Coll Physicians Surg Pak. 2011 Jan;21(1):37-9.
We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic seizures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there was complete resolution of neurological symptoms. We highlight the importance of high index of suspicion of this reversible encephalopathy in obstetric cases with intentional or inadvertent dural puncture, with headache similar to post-dural punctural headache, and the essential role of neuroradiology in confirmation of the diagnosis, as placement of an epidural blood patch would be highly detrimental in these cases.
我们报告了一例36周妊娠的年轻患者，其患有急性呼吸道感染并伴有严重支气管痉挛，在剖宫产联合硬膜外脊髓麻醉置管时意外发生硬膜穿刺，第三天出现枕部头痛和颈部疼痛。在诊断为硬膜穿刺后头痛后，第二天患者出现全身性强直阵挛发作，这引发了产后子痫或脑膜炎的怀疑。脑部MRI诊断为后部可逆性脑病综合征，显示脑部后部存在可逆性缺血特征。经过抗惊厥治疗和抗生素治疗，神经症状完全缓解。我们强调，对于产科中有意或无意硬膜穿刺且伴有类似硬膜穿刺后头痛的头痛情况，高度怀疑这种可逆性脑病至关重要，同时神经放射学在确诊中起着关键作用，因为在这些病例中放置硬膜外血补丁可能会造成极大损害。
