A 33-year-old woman with severe postpartum headache
EMERGENCY ,
Vol. 1 No. 1 (2013),
1 December 2013
,
Page pp. 27-29
https://doi.org/10.22037/emergency.v1i1.5333
Abstract
Patient was a 33-year-old woman underwent her first time cesarean section combined with spinal epidural anesthesia 5 days before and discharged the day after with good condition. She got severe headache with pain score about 8-9, 2 days after discharge from hospital. Her headache was severe, bilateral, pulsatile and almost likely sudden onset accompanied with nausea that mildly progressed after starting. She went to the hospital which her delivery was taken; with impression of Post Dural Puncture Headache (PDPH) 10mg IV morphine sulfate was administered totally and subsequently discharged home with relative decreased headache. The day after first headache attack, when she admitted in our Hospital, claimed that could not hold her baby for breast feeding. In minimental status examination, time disorientation was obvious but orientation to place and person was intact. In motor examination we found right side hemiparesis and also decreased right upper and lower limbs tone. Brain CT Scan and then MRI was performed and reveal massive cortico-subcortical hemorrhagic infarction on left parieto-occipital lobes. With attention due to significant nonhomogene occupying lesion, brain MRI with gadolinium and also MRV was per-formed.
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References
Macarthur A. Postpartum headache. In: Chestnut DH PL, Tsen LC, Wong CA, editor. Chestnut’s Obstetric Anesthesia Principles and Practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. p. 677–700.
Sabharwal A, Stocks G. Postpartum headache: diagnosis and management; Continuing Education in Anaesthesia. Crit Care Pain. 2011;11(5):181-5.
Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? Am J Obstet Gynecol. 2007;196(4):1-7.
Vodnik T, Ignjatovic S, Majkic-Singh N. Changes in the plasma levels of protein C system parameters in pregnancy. Scand J Clin Lab Invest. 2003;63(7-8):481-8.
Gao H, Yang B-J, Jin L-P, Jia X-F. Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum: a case-control study. Chin Med J. 2011;124(24):4198.
Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke. 2000;31(6):1274-82.
Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-8.
Rizzo L, Crasto SG, Rudà R, et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol Med. 2010;115(2):313-25.
Murugappan A, Coplin W, Al-Sadat A, et al. Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology. 2006;66(5):768-70.
Chan K, Cheung R, Liu W, Mak W, Ho S. Cerebral venous thrombosis in a gentleman presenting with fever, convulsion and frontotemporal haemorrhages. J Clin Neurosci. 2005;12(2):186-8.
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