1/10. Treatment for postdural puncture headache associated with late postpartum eclampsia.Postdural puncture headache (PDPH) is the most common complication of accidental or deliberate dural puncture. It also occurs after epidural or spinal analgesia for labor and delivery. Treatment may be conservative with analgesics and/or caffeine. Definitive treatment can be accomplished with an epidural blood patch (EBP). We present a case of postpartum convulsions which were temporally related to a caffeine infusion and an EBP.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
2/10. Postpartum headache after epidural blood patch: investigation and diagnosis.Use of an epidural blood patch to treat spinal headache after accidental dural puncture is well recognized. The high success rate associated with this practice has been questioned and it is not uncommon for patients to suffer recurring headaches after a supposedly successful blood patch. We describe a patient in labour who suffered accidental dural puncture, and whose headache was treated twice with an epidural blood patch. Despite this, the headache persisted. The case highlights the difficulty in the diagnosis of headache in the postnatal period in patients who have had regional analgesia and the importance of considering an alternative pathology, even if epidural blood patching has been successful. In this case, a diagnosis of cortical vein thrombosis was made. The incidence, presentation, aetiology and treatment of this rare condition is described.- - - - - - - - - - ranking = 2keywords = accident (Clic here for more details about this article) |
3/10. Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14. A transcranial Doppler ultrasonography showed vasospasm of the left middle cerebral artery still present at 3-month follow-up. At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.- - - - - - - - - - ranking = 4keywords = accident (Clic here for more details about this article) |
4/10. Postpartum post-dural puncture headache: is your differential diagnosis complete?We describe a patient with an intracerebral haemorrhage following an accidental dural puncture during an attempted epidural for pain relief in labour. Anaesthetists need to include intracerebral haemorrhage in the differential diagnosis of post-dural puncture headache in the puerperium.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
5/10. Emergency department presentation of bilateral carotid artery dissections in a postpartum patient.Spontaneous unilateral postpartum carotid arterial dissection is a rarely reported event. This is the first reported case of bilateral carotid artery dissection. A 35-year-old gravida 4, para 3 woman presented to our emergency department with complaint of headache for 3 days. Medical history included delivery of a full-term infant by cesarean section 9 days before presentation because of arrest of descent after 3 hours of pushing. Symptoms were later attributed to a parietal lobe cerebral vascular accident and bilateral internal carotid artery dissection. physicians should consider the possibility of arterial dissection in any postpartum patient with unremitting headache when evaluation of typical causes fails to lead to a diagnosis. Appropriate diagnostic evaluation and treatment should be actively pursued in this population.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
6/10. Cerebrovascular accident with quadriplegia following postpartum eclampsia.A 26-year-old woman (para 1 0) was managed at the National Hospital, Abuja, nigeria for postpartum eclampsia with quadriplegia following referral from a peripheral hospital with a history of a solitary tonic/clonic seizure and unconsciousness. Her antenatal period had been uneventful until she presented with labour pains, where examination revealed an elevated blood pressure. She fitted once after delivery and remained unconscious for more than 12 h, hence the referral. The patient was managed in the intensive care unit (ICU), where she was found to be quadriplegic. She received mechanical ventilation for 21 days as part of her management in the ICU. Despite multidisciplinary care, she remained quadriplegic until a doctors' strike precluded further in-patient management. This rare complication of eclampsia is discussed, together with the patient's management.- - - - - - - - - - ranking = 4keywords = accident (Clic here for more details about this article) |
7/10. The completeness of the afterbirth: a medical/pathological discussion.Practical problems (with possible medicolegal implications) regarding the interpretation of the completeness of the afterbirth are discussed. The case material was obtained during surgical pathological examination and, later, at the time of autopsy of the same patient. The mother (three weeks following emergency delivery) succumbed to life-threatening complications of an epidural anesthetic accident.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
8/10. Puerperal psychosis following ablaction with bromocriptine.Addiction in the context of drug abuse usually is perceived as habitual dependence on the part of the consumer of a potentially habit forming drug. attention is drawn to an alternative pattern of drug abuse, namely, unwarranted prescription of drugs on the part of physicians. An example of what the writers perceive is the habitual distribution of a potentially harmful drug in the absence of a clear-cut indication. attention is being drawn to the worldwide use of bromocriptine, an agent suspected of causing occasional vasospasm, hypertensive cerebral accident and myocardial infarction, for the purpose of ablactation. An additional observation is described where, following administration of bromocriptine in the puerperium manifestations consistent with ergotism developed. The clinical picture was also consistent with pure puerperal psychosis. attention is also drawn to the likelihood of a cause-effect relationship between the abovementioned drug (an ergot derivative) and the ensuing psychotic reaction.- - - - - - - - - - ranking = 1keywords = accident (Clic here for more details about this article) |
9/10. The management of headache following accidental dural puncture in obstetric patients.The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. A therapeutic autologous blood patch using 8-10 ml of blood was performed in 28 patients at least 24 hours after the accidental puncture. Dramatic and permanent relief occurred in 75% following this procedure. A repeat blood patch was effective in four patients and ineffective in the remaining two. Mild and temporary back stiffness and one case of moderately severe radicular pain for three days were the only complications noted after the procedure. The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.- - - - - - - - - - ranking = 6keywords = accident (Clic here for more details about this article) |
10/10. Severe cerebral accidents postpartum in patients taking bromocriptine for milk suppression.We report three recent cases of severe acute cerebral accident which occurred in the puerperium in women who received bromocriptine for milk suppression. Two patients experienced mild pregnancy-induced hypertension antepartum. Marked blood pressure elevation, above that which had prevailed previously, occurred postpartum in each case. The cerebral accidents manifested between the 6th and 14th days of the puerperium, the typical time for the occurrence of severe side effects from bromocriptine. These complications entailed lasting neurological sequelae in the three mothers who, based on their age, medical history and general state of health, were not significantly predisposed to cerebral accidents.- - - - - - - - - - ranking = 7keywords = accident (Clic here for more details about this article) |
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