A rare cause of postpartum headache: Gliobastoma multiforme
Abstract Number: S-61
Abstract Type: Case Report/Case Series
Introduction: We describe the management of a parturient with an undiagnosed large glioma who underwent spinal anaesthesia for Caesarean Section (CS) and suffered from a postpartum headache.
Case report: A 40 yr old para 2 at 35 wks gestation with placenta praevia presented for emergency CS. Spinal anaesthesia was performed to facilitatae CS and delivery of a healthy baby boy. 11 days later the patient was referred to anaesthesia with a potential post dural puncture headache. The patient described an occipitoposterior headache with a very slight postural component not associated with any neurological features. An Epidural blood Patch (EBP) was not performed. Simple analgesia and hydration were recommended and the patient discharged home. 3 days later, the patient was re-referred to anaesthesia with continued headache now associated with drowsiness and confusion. Urgent CT showed a right frontal cystic tumour with enhanced oedema and midline shift as in Fig.1.
The next day a right frontal craniotomy and debulking was conducted. Histology revealed a high grade glial tumour consistent with grade 4 gliobastoma.
Discussion: Firstly, it is surprising yet reassuring that spinal anaesthesia did not have significant complications. There have been case reports of brain herniation following spinal anaesthesia in patients with unknown intracerebral tumours (1). General anaesthesia would have been our first choice had we known. Secondly, this is a stark reminder that intracranial tumours, although rare, must be considered as a differential diagnosis for postpartum headache(2). In one study of 126,000 deliveries, 7 had brain tumours(3). Finally, had an EBP been carried out, there may have been fairly devastating sequelae particularly if there had been an inadvertent dural puncture. Should imaging be routinely carried out prior to EBP?
1. Metterelein et al. Coma after spinal anaesthesia in a patient with an unknown intracerebral tumour. Acta Anaesthesiol Scand 2010 Oct; 54(9): p1149-51
2. Smith IF, Skelton V. An unusual intracranial tumour presenting in pregnancy. IJOA 2007 Jan; 16(1); p82-85.
3. Isla A et al. Brain tumour and Pregnancy. Obstet Gynecol 1997; 89; p19-23