title: A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia.
abstract: We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA. Electronic address: jbordlee@tulane.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Bordlee
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Burton D
authors.initials: BD
authors.lastname: Beakley
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Rayomond
authors.initials: R
authors.lastname: Mody
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Anne P
authors.initials: AP
authors.lastname: McConville
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Weed
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: McClure
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Foldes
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Ma
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Eskander
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D065634:Cerebrospinal Fluid Leak / Q000150:complications*; D036861:Delivery, Obstetric / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D020910:Ketorolac / Q000627:therapeutic use; D007741:Labetalol / Q000627:therapeutic use; D009339:Needles; D017294:Ondansetron / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D051299:Post-Dural Puncture Headache / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011247:Pregnancy
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; C514822:oxycodone-acetaminophen; D000082:Acetaminophen; D017294:Ondansetron; D010098:Oxycodone; D007741:Labetalol; D005283:Fentanyl; D002045:Bupivacaine; D020910:Ketorolac
keywords: CSE; Combined spinal-epidural; Dural puncture; Epidural; Paradoxical postdural puncture headache; Spinal headache