title: [Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture].
abstract: A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.
authors.affiliation: Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, España. Electronic address: juliancastrocastro@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Castro-Castro
authors.affiliation: Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España.
authors.forename: O
authors.initials: O
authors.lastname: Figueiredo-González
authors.affiliation: Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España.
authors.forename: A
authors.initials: A
authors.lastname: Río-Gómez
authors.affiliation: Servicio de Anestesiología y Reanimación, Complexo Hospitalario Universitario de Ourense, Ourense, España.
authors.forename: N
authors.initials: N
authors.lastname: Carballo-Loureiro
authors.affiliation: Servicio de Neurocirugía, Complexo Hospitalario Universitario de Ourense, Ourense, España.
authors.forename: D
authors.initials: D
authors.lastname: Castro-Bouzas
mesh_terms: D000059:Accidents; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D001933:Brain Stem / Q000503:physiopathology*; D003244:Consciousness Disorders / Q000209:etiology*; D056424:Decompressive Craniectomy; D003937:Diagnosis, Differential; D004388:Dura Mater / Q000293:injuries*; D004677:Encephalocele / Q000209:etiology*; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D015192:Infratentorial Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D009442:Neurilemmoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D059906:Neuroimaging; D051299:Post-Dural Puncture Headache / Q000175:diagnosis*; D011247:Pregnancy; D011312:Pressure / Q000009:adverse effects; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology*; D011677:Punctures / Q000009:adverse effects*
keywords: Analgesia epidural; Brain tumour; Cefalea; Dural puncture; Epidural analgesia; Headache; Labour; Parto; Punción dural; Tumor cerebral