Cases reported "Puerperal Disorders"

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1/14. 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.
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2/14. 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.
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3/14. Homonymous hemianopia following a triplet pregnancy: post-natal cerebral vasculitis or atypical eclampsia.

    A 46-year-old woman with a triplet pregnancy developed seizures, an oculogyric crisis and a homonymous hemianopia post-natally. Abnormal neuroimaging studies and lumbar puncture suggested possible cerebral vasculitis. Treatment with aciclovir and prednisolone resulted in a slow resolution of symptoms. This case highlights the difficulty in distinguishing eclampsia from rarer neurological causes of peripartum seizures.
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4/14. 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.
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5/14. Recurrent post-partum seizures after epidural blood patch.

    There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.
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6/14. Late postpartum eclampsia coincident with postdural puncture headache: a case report.

    Preeclampsia developed in this patient 4 days' postpartum. Visual changes, headache, and elevated blood pressures were present on arrival to the emergency department. Coincident with the preeclampsia was a postdural puncture headache complicating the diagnosis of late postpartum preeclampsia. pregnancy-induced hypertension laboratory values were normal, and relief of the postdural headache and visual disturbances was obtained after placement of an epidural blood patch. blood pressures continued to increase, however, and late postpartum eclampsia developed. We conclude that symptoms of a postdural puncture headache can mimic those of postpartum preeclampsia. Early recognition and treatment of postpartum preeclampsia may decrease patient mortality and morbidity by preventing late postpartum eclampsia.
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7/14. 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.
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8/14. Grand mal seizure in a postpartum patient following intravenous infusion of caffeine sodium benzoate to treat persistent headache.

    A 27-year-old parturient developed a severe headache after placement of a labor epidural catheter. A presumptive diagnosis of an occult postdural puncture headache (PDPH) was made, and the patient was treated with an intravenous (IV) infusion of 500 mg of caffeine sodium benzoate (CSB) to vasoconstrict dilated cerebral vessels. Shortly after the infusion was completed, the patient experienced a self-limited grand mal seizure, which recurred later during her hospitalization. Despite a neurologic consultation and extensive testing, no definitive cause for the seizure was found. In light of the temporal relationship between caffeine use and the development of seizure activity, reports implicating caffeine's contribution to seizure activity, and evidence of a prolongation of the substance's half-life during and after pregnancy, we urge caution in the use of this drug in parturients.
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9/14. Postpartum headache, seizures and bloodstained C.S.F.: a possible complication of dural puncture?

    A 32-year-old parturient developed severe headache with subsequent convulsions on the third day after the delivery under epidural anesthesia. Neuroradiological investigations were negative. All complaints disappeared promptly after the performance of an epidural blood patch.
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10/14. Postpartum cervical myofascial pain syndrome: review of four patients.

    Four postpartum patients with complaints of headache and neck pain were examined. All had received epidural analgesia and had a long second stage associated with prolonged pushing. Many similarities to postdural puncture headache were noted. The headache started the day after delivery and involved the occipital region primarily, along with the neck and shoulder girdle areas. However, the pain did not change with positional changes and was associated with marked tenderness of muscles at specific anatomic points. A diagnosis of cervical myofascial pain was made. All patients responded quickly to physical therapy. The authors suggest that many patients initially considered to have postdural puncture headache may actually have postpartum cervical myofascial pain.
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