| Differential Diagnosis of Postpartum Headache between Post-Dural Puncture Headache and Intracerebral Hemorrhage: A case report. |
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Suk Young Lee, Min Ah Kwon, Duck Hwan Choi |
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Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dhchoi@smc.samsung.co.kr |
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| Abstract |
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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. |
| Key Words:
cesarean section; combined spinal-epidural anesthesia; epidural blood patch; intracerebral hemorrhage; post-dural puncture headache |
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