Puerperal seizures after post-dural puncture headache.
OBJECTIVE
To describe eight cases of postpartum women who developed seizures associated with post-dural puncture headache.


METHODS
Between the years 1982-1991, more than 19,000 women at our institution underwent subarachnoid analgesia for delivery or puerperal tubal sterilization. In eight of these women, grand mal seizures developed after spinal headache.


RESULTS
In all eight women, typical post-dural puncture headaches were followed by visual disturbances that progressed to cortical blindness in three. These headaches and visual disturbances culminated in generalized tonic-clonic seizures 2-7 days after dural puncture. Although some of these women had transient hypertension at the time of seizure, none had preeclampsia. In three of the women evaluated, there was evidence of regional blood flow changes; two had diffuse cerebral artery vasospasm seen on angiography, and the third had diminished blood flow detected by a xenon-flow study.


CONCLUSIONS
We propose that cerebral vasoconstriction is the mechanism for post-dural puncture headaches and seizures. Anatomic brain displacement may incite this vasospasm. This mechanism could also be the cause of cranial nerve palsies that have been described after dural puncture.
Shearer
V E
VE
Department of Anesthesiology, University of Texas Southwestern Medical Center at Dallas.
Jhaveri
H S
HS
Cunningham
F G
FG
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D001766:Blindness / Q000209:etiology; D002560:Cerebrovascular Circulation; D017023:Coronary Angiography; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D012640:Seizures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013129:Spinal Puncture / Q000009:adverse effects*; D013246:Sterilization, Tubal