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- W2430322966 abstract "OBJECTIVE: To describe an uncommon cause of thunderclap headache in the peripartum setting. BACKGROUND: Headache resulting from dural puncture is almost always secondary to a cerebrospinal fluid leak and occurs post epidural anesthesia. Pneumocephalus may rarely occur in this setting but the pattern of headache and neurological deficits have not been well-described when occurring after dural puncture. DESIGN/METHODS: Case report from a tertiary medical center. RESULTS: A 30 year old healthy woman with a history of infrequent migraine without aura underwent lumbar epidural anesthesia for a delivery at term. Within seconds of catheter insertion she experienced a sudden, explosive, maximal at onset right frontal headache and neck pain, remarkably worse during recumbency but improved when upright. After an uneventful delivery she developed right ptosis, mydriasis, and binocular vertical diplopia on left gaze. Examination was notable for nuchal rigidity and a right third cranial nerve palsy. Brain MRI revealed air (pneumocephalus) in the left lateral ventricle and suprasellar cistern. The patient9s headache and ophthalmoparesis resolved with high flow oxygen and nonsteroidal anti-inflammatory agents. CONCLUSIONS: Pneumocephalus following inadvertent intrathecal air administration should be considered as a possible etiology of thunderclap headache in the setting of epidural anesthesia. Clinical clues to the diagnosis that distinguish the syndrome from a CSF leak may include a severe headache at the onset of catheter insertion rather than a delayed pattern, and a headache that exacerbates in recumbency but abates when upright, which could reflect air recirculation to structures that are particularly pain sensitive or obstruct CSF flow. Disclosure: Dr. Honchar has nothing to disclose. Dr. Robbins has nothing to disclose." @default.
- W2430322966 created "2016-06-24" @default.
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- W2430322966 date "2013-02-12" @default.
- W2430322966 modified "2023-09-23" @default.
- W2430322966 title "Thunderclap Headache Associated with Pneumocephalus in Epidural Anesthesia (P06.152)" @default.
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