Cerebral venous thrombosis after epidural blood patch: coincidence or causal relation? A case report and review of the literature.
We report on a female patient who developed post-dural puncture headache (PDPH) after epidural analgesia for delivery. Treatment with epidural blood patch led to complete headache remission and the patient was discharged. Two days later the patient was readmitted with hemihypaesthesia and mild hemiparesis of the right side. Magnetic resonance imaging showed a small left parietal cortical haemorrhage probably following cerebral venous thrombosis (CVT). Coagulation screening detected heterozygous Factor V mutation. Headache is a common symptom of PDPH and CVT. Review of the literature revealed five patients in puerperal state, who developed CVT in close temporal relationship after blood patch treatment for PDPH. Change of headache character with loss of postural influence was reported frequently before diagnosis of CVT was confirmed. These findings may indicate a causal relationship.
Kueper
M
M
Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany. michael.kueper@uni-duisburg-essen.de
Goericke
S L
SL
Kastrup
O
O
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D017217:Blood Patch, Epidural / Q000009:adverse effects*; D015984:Causality; D002543:Cerebral Hemorrhage / Q000097:blood / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D005165:Factor V / Q000235:genetics; D005260:Female; D006580:Genetic Carrier Screening; D051271:Headache Disorders, Secondary / Q000209:etiology / Q000628:therapy*; D006801:Humans; D020767:Intracranial Thrombosis / Q000097:blood / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D009154:Mutation; D010296:Parietal Lobe / Q000098:blood supply*; D011644:Puerperal Disorders / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology*
C095381:factor V Leiden; D005165:Factor V