Dr Song He1, Dr Sioh Huang Lim1, Dr Manisha Mathur1, Dr Deepak Mathur
1Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
Biography:
Dr He Song graduated from Duke-NUS Medical School Singapore with an M.D. She was admitted as a Member of the Royal College of Obstetricians and Gynaecologists (MRCOG) UK in 2021. She is a specialist in Obstetrics and Gynaecology in Singapore. One of her research interests is maternal health.
Abstract:
Introduction: Up to 39% of women experiences headaches in the postpartum period. The differential diagnoses for headache in the postpartum period are broad, and present a diagnostic challenge. Seizures in the postpartum period are not well studied and its etiology often remains unclear.
Case report: A 33-year-old primigravida presented six days post-delivery with a headache and was diagnosed with post dural puncture headache. Blood tests were unremarkable and brain imaging demonstrated evidence of intracranial hypotension with no other abnormalities. She received an epidural blood patch the next day and developed a seizure shortly after the procedure. A transient rise in blood pressure and transient urinary proteinuria was also observed during this period.
Conclusion: Postpartum headaches are common and the features of post-dural puncture headaches are well studied. Seizure following epidural blood patch for post-dural puncture headache is rare, although it has been described in some reports. Intracranial structural pathologies were identified in most of these cases. However, in the early postpartum period, it is also important to evaluate for postpartum eclampsia. In the absence of organic pathology, seizure as a direct result of epidural blood patch should be considered.
Keywords
postpartum seizure, eclampsia, post dural puncture headache
References
1. Al-Hashel, J., Rady, A., Massoud, F., & Ismail, I. I. (2022). Post‐dural puncture headache: A prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurology, 22, 261. https://doi.org/10.1186/s12883-022-02785-0
2. Causer, E., Birchall, I., Simchovich, G., & Pascoal, E. (2023). Postpartum seizure as a complication of dural puncture and intracranial hypotension. CMAJ, 195(26), E905–E908. https://doi.org/10.1503/cmaj.230063
3. Prichard, A., Appiah, S., Kearsley, R., & Arnold, G. (2022). Seizures after epidural blood patch in a postpartum patient later diagnosed with hypertension and proteinuria: A diagnostic conundrum. Anaesthesia Reports, 10(1), e12149. https://doi.org/10.1002/anr3.12149