title: Severe headache following an epidural 'top-up'.
abstract: Half an hour after a normal delivery under epidural analgesia, a patient was given a top-up of 10 ml 0.25% bupivacaine for suture of a small vaginal tear. The patient developed severe headache, nausea and vomiting immediately after the top-up. Initially these symptoms were attributed to a complication of epidural analgesia. However, a raised epidural pressure led to a diagnosis of hypertensive encephalopathy.
authors.affiliation: Department of Anaesthetics, Dudley Road Hospital, Birmingham, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Shah