title: Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.
abstract: 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.
authors.affiliation: Università di Roma La Sapienza, Ospedale S. Andrea, Rome, Italy. mamerx@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Mercieri
authors.forename: A
authors.initials: A
authors.lastname: Mercieri
authors.forename: S
authors.initials: S
authors.lastname: Paolini
authors.forename: R
authors.initials: R
authors.lastname: Arcioni
authors.forename: D
authors.initials: D
authors.lastname: Lupoi
authors.forename: F
authors.initials: F
authors.lastname: Passarelli
authors.forename: G
authors.initials: G
authors.lastname: Pinto
authors.forename: D
authors.initials: D
authors.lastname: Celleno
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D017217:Blood Patch, Epidural / Q000009:adverse effects*; D002545:Brain Ischemia / Q000209:etiology*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D020773:Headache Disorders / Q000209:etiology; D006801:Humans; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D014950:Wounds, Penetrating / Q000150:complications*