Lim Rachael S, Chan Ethan K, Das Partha P, Ibrahim Tunde
Critical Care, Goulburn Valley Health, Shepparton, AUS.
General Medicine, Goulburn Valley Health, Shepparton, AUS.
Cureus. 2024 May 13;16(5):e60183. doi: 10.7759/cureus.60183. eCollection 2024 May.
Post-dural puncture headache (PDPH) is a common complication of epidural and spinal anaesthesia in obstetric medicine. In rare cases, PDPH can be associated with complications such as cerebral venous thrombosis (CVT) as well. We discuss a recent case of a young female who developed PDPH and CVT concurrently after undergoing epidural anaesthesia for initially uncomplicated labour and delivered via an emergency caesarean section. She developed an orthostatic headache a few hours post administration of the epidural anaesthetic, which was initially treated as a suspected PDPH by giving simple analgesia and caffeine. Her symptoms did not improve and she underwent further neuroimaging, which revealed the development of a CVT. Despite the prompt administration of enoxaparin, the headache persisted and did not respond to increased doses of analgesia. After deliberation and inter-departmental discussion, an epidural blood patch was performed, leading to the prompt resolution of the headache. This report highlights a rare concurrence of PDPH and CVT, causing a diagnostic dilemma that resulted in treatment delays for the patient. Treating both conditions raises difficult practical questions, especially regarding the use of an epidural blood patch as opposed to anticoagulation. Given the risk of fatal complications such as venous cerebral infarction, seizures, and subdural hematoma, prompt treatment of both PDPH and CVT is strongly recommended. The multifactorial mechanism by which CVT develops with intracranial hypotension and PDPH also makes it essential for clinicians to keep an open mind when managing post-caesarean headaches, requiring inter-departmental cooperation to ensure optimal patient outcomes.
硬膜穿刺后头痛（PDPH）是产科医学中硬膜外麻醉和脊髓麻醉的常见并发症。在罕见情况下，PDPH也可能与诸如脑静脉血栓形成（CVT）等并发症相关。我们讨论了最近一例年轻女性的病例，该女性在最初分娩过程顺利的情况下接受硬膜外麻醉后并发PDPH和CVT，并通过急诊剖宫产分娩。硬膜外麻醉给药后数小时，她出现了直立性头痛，最初通过给予简单镇痛和咖啡因将其作为疑似PDPH进行治疗。她的症状没有改善，随后进行了进一步的神经影像学检查，结果显示发生了CVT。尽管迅速给予了依诺肝素，但头痛仍持续存在，且对增加剂量的镇痛药物无反应。经过深思熟虑和跨部门讨论后，进行了硬膜外血贴治疗，头痛迅速缓解。本报告强调了PDPH和CVT罕见的同时发生情况，这导致了诊断困境，进而导致患者治疗延迟。同时治疗这两种疾病引发了棘手的实际问题，尤其是在使用硬膜外血贴而非抗凝治疗方面。鉴于存在诸如静脉性脑梗死、癫痫发作和硬膜下血肿等致命并发症的风险，强烈建议对PDPH和CVT进行及时治疗。CVT与颅内低血压和PDPH并发的多因素机制也使得临床医生在处理剖宫产术后头痛时必须保持开放的思维，需要跨部门合作以确保患者获得最佳治疗效果。
