From the Department of Clinical Neurosciences (L.C., H.F., P. Michel, D.S.), Neurology Service, and Department of Medical Radiology (P. Maeder), Radiodiagnostic and Interventional Radiology Service, Lausanne University Hospital and University of Lausanne, Switzerland.
Neurology. 2022 Oct 10;99(15):665-668. doi: 10.1212/WNL.0000000000201111.
We report the case of a 34-year-old female patient complaining of headaches 1 day after childbirth, initially interpreted as postdural puncture headache (PDPH) and treated successfully with an epidural blood patch. Five days later, she presented with an acute proportional right sensorimotor hemisyndrome and a new-onset left-sided headache, attributed to a venous stroke from left-sided cerebral sinus venous thrombosis (CSVT). Simultaneously, we found radiologic signs of reversible cerebral vasoconstriction syndrome (RCVS), considered asymptomatic. We administered anticoagulant therapy to the patient, and she showed full motor recovery at 3-month clinical follow-up. PDPH, CSVT, and RCVS are well-known neurologic complications during the peripartum period. All 3 conditions present with headaches, and headache features may overlap, masking co-occurrence and making accurate diagnosis (differentiation) of these diseases difficult. Each disease can potentially lead to disabling deficits, but all respond to specific treatment. Knowledge of the causes of headaches in the peripartum period, their specific clinical characteristics, and potential complications helps to prioritize and interpret diagnostic tests to offer appropriate therapy.
我们报告了一例 34 岁女性患者的病例，该患者在分娩后 1 天出现头痛，最初被解释为硬脊膜穿刺后头痛（PDPH），并成功地接受了硬膜外血贴治疗。5 天后，她出现了急性右侧感觉运动偏瘫综合征和新发的左侧头痛，归因于左侧大脑窦静脉血栓形成（CSVT）引起的静脉性中风。同时，我们发现了可逆性脑血管收缩综合征（RCVS）的放射学征象，被认为是无症状的。我们给患者进行了抗凝治疗，她在 3 个月的临床随访时完全恢复了运动功能。PDPH、CSVT 和 RCVS 是围产期常见的神经系统并发症。所有这 3 种情况都伴有头痛，头痛的特征可能重叠，掩盖了同时发生的情况，使这些疾病的准确诊断（鉴别）变得困难。每种疾病都可能导致残疾，但都对特定的治疗有反应。了解围产期头痛的原因、其特定的临床特征和潜在的并发症有助于确定诊断测试的优先级并对其进行解释，以提供适当的治疗。
