Postpartum cerebral venous sinus thrombosis after dural puncture and epidural blood patch

Abstract

n 18-year-old woman presented to the Emergency Deartment (ED) with a chief complaint of headache. Eleven ays before presentation she underwent a caesarian section ith epidural anesthesia. The epidural catheter placement as problematic, according to the patient, and required ultiple attempts. Shortly after delivery, the patient develped a headache, which was described as generalized and ild. She recounted that early on there was a postural omponent to the headache. The headache became progresively worse, however, prompting the patient to present to nother ED on postoperative day 8. At that visit she was iagnosed as having a post-dural puncture headache and n epidural blood patch was placed in an attempt to elieve her symptoms. She was subsequently discharged o home with a prescription for a narcotic analgesic. The patient reported that the blood patch and oxyodone did not help, and that the headache was still resent. She described the quality as dull and throbbing nd unlike any previous headaches. She described the ocation as in the occipital region and stated that the haracter of the headache had changed somewhat since he administration of the blood patch, such that there was o longer any postural component. She denied having ny fevers, vomiting, neck stiffness, or photophobia. On physical examination the young woman appeared ncomfortable but was in no acute distress. She was febrile with normal vital signs. The head was without