Postpartum postural headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension

Citation
Me. Chisholm et Dc. Campbell, Postpartum postural headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension, CAN J ANAES, 48(3), 2001, pp. 302-304
Citations number
2
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
ISSN journal
0832610X → ACNP
Volume
48
Issue
3
Year of publication
2001
Pages
302 - 304
Database
ISI
SICI code
0832-610X(200103)48:3<302:PPHDTS>2.0.ZU;2-2
Abstract
Purpose: To describe a case of superior sagittal sinus thrombosis in the pu erperal period and the difficulties encountered in the diagnosis and manage ment. Clinical features: A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. Initial presentation suggested spontaneous intracranial hypotension (SIH) since th ere was no history of epidural or spinal anesthesia, or trauma or surgery t o her back or neck. Conservative therapy was initially offered and then a l umbar epidural blood patch (LEBP) was performed, although it failed to reli eve the postural headache. A dural leak could not be demonstrated but an MR V (magnetic resonance venography) revealed a superior sagittal sinus thromb osis (SSST). Although anticoagulant therapy was immediately initiated, the neurologist remained convinced that the postural headache was secondary to SIH, and, consequently. a second epidural blood patch was requested. Anesth esia was reluctant to perform an LEBP at this point and suggested continuin g anticoagulation until a subsequent MRV demonstrated recannalization of th e SSST. This advice was followed and the postural headache resolved spontan eously with intravenous anticoagulation, Conclusion: The present case illustrates the importance of a multidisciplin ary approach to the management of this rare complication of pregnancy. This case also highlights the importance of reviewing the differential diagnosi s when considering treatment of a postural headache in the puerperium.