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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Post-Partum Headache with Bell's Palsy as Initial Presentation of Severe Pre-Eclampsia: A Case Report

Abstract Number: 250
Abstract Type: Case Report/Case Series

Derek L Foerschler D.O.1 ; Kenneth R Moran M.D.2

A twenty-nine year-old gravida 1 female presented at an estimated gestational age of 40 weeks, 5 days for induction of labor. Blood pressure (B/P) in the antepartum period ranged between 127-155 mmHg systolic and 64-87 mmHg diastolic.

A lumbar epidural was placed after starting oxytocin but initial attempt of catheter placement resulted in aspiration of blood. A second attempt resulted in successful placement without complication. Pain control diminished and the epidural catheter was eventually replaced. There was no indication with any attempt that dural puncture occurred.

On post-partum day (PPD) #1, the patient developed a headache of moderate severity (6/10). The patient localized pain to the occipital area with a marginal positional component and no photophobia or nausea. Focused neurologic evaluation provided findings within normal limits. B/P of 137/62 was noted. IV caffeine, hydration and oral analgesics were provided with resolution of symptoms. She was discharged on PPD #2.

The patient was contacted by phone on PPD# 4 by our service as routine follow-up. She described recurrence of her headache with worsening severity despite oral analgesics. It was learned at this time that she developed a left facial droop a few hours prior to discharge. She had been discharged on oral steroids with a diagnosis of Bells Palsy and a six-week follow-up was scheduled. We advised the patient to go to the ER for further evaluation of her headache.

Admission vital signs showed a BP of 189/90. A CT done for shortness of breath showed large pleural effusions. Treatment of labetalol, IV furosemide and magnesium infusion was initiated. LFT elevation was noted with development of significant proteinuria PPD#7. TTE on PPD# 5 revealed normal function with a LVEF of 45-50%. Complete resolution of headache occurred on PPD#5. Her neurologic exam showed persisting left-sided facial droop with left eyelid involvement. The patient was discharged on PPD #6 on oral labetalol with close primary follow-up.

This case illustrates the complexities of the evaluation of post-partum headache. Several potential sources of headache in post-partum women exist. Indeed, an item of primary concern by the anesthesia provider is an associated dural puncture, but the differential cannot stop there. Pre-eclampsia must be considered in postpartum headache evaluation. Stella et al., showed headaches that began >24 hours after delivery to be associated with pre-eclampsia in 24%, only16% of those studied had spinal headaches.

Our patients presentation of headache and Bells Palsy may have been an early neurological sign of impending severe post partum pre-eclampsia. The diagnosis of postdural puncture headache is an important aspect of our postpartum evaluation, however, the concern for postdural puncture headache should not preclude vigilant evaluation and monitoring for the presence of postpartum pre-eclampsia.

SOAP 2010