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.
Mercieri
M
M
Università di Roma La Sapienza, Ospedale S. Andrea, Rome, Italy. mamerx@yahoo.com
Mercieri
A
A
Paolini
S
S
Arcioni
R
R
Lupoi
D
D
Passarelli
F
F
Pinto
G
G
Celleno
D
D
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*