///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Cortical Vein Thrombosis after Lumbar Epidural and PDPH: A Case Report & Literature Review

Abstract Number: RF5BH-500
Abstract Type: Case Report Case Series

M. Waseem Athar MBBS, DESA, MCAI1 ; Umar Mushtaq MBBS, DESA2; Roshan G Fernando MBBS, FRCA3

Introduction:

Complications of labor epidural analgesia include an accidental dural puncture (ADP) which can lead to headache in 50-80% patients. Cortical vein thrombosis(CVT) is an uncommon condition in pregnancy with the incidence quoted as 1:10 000 to 1:25 000. Headache is the commonest presentation of CVT but it is difficult to pick up with a background of ADP. We describe the case of a woman who had labor epidural complicated by an ADP, and subsequently developed PDPH.

Case Report: 24 Years old healthy G2P1 admitted to labor room requested labor epidural analgesia. CSE was done after multiple attempts and suspected ADP. Next day, patient complained of headache which was occipitofrontal and aggravated by sitting up. There was no neurological deficit. History and examination were very much suggestive of PDPH so she was started on regular analgesics without any improvement in a day. After discussing options of conservative management and blood patch, patient opted for pharmacological management. On 3rd day post-delivery, her headache was relieved, and she was discharged home. She came back on 6th post-delivery day with complaints of headache with typical postural variation & occasional tinnitus. EBP was offered which she accepted. EBP was done and 19ml of blood given at L3/L4 & headache was relieved immediately. Around 7 hours after EBP, patient had tonic clonic convulsions. On examination, patient was awake, not oriented with GCS 13. Patient became oriented in 10 minutes. Pupils were equal in size and reacting to light. There was no neurological deficit and no neck stiffness. Her vital signs were normal except tachycardia 115/min. Differential diagnosis considered included intracranial events, epilepsy, eclamptic fit, vasovagal syncope. CT head done 4 hours after that event showed thrombosis in the superficial cortical vein. Patient was started on anticoagulant therapy. MRV showed thrombosed dilated tortuous cortical vein in the high right frontal lobe region. She was discharged home on 11th post-delivery day. Her workup showed mutation for factor V Leiden putting her on 2-10 fold increased risk for VTE. Pt was counseled for lifelong anticoagulant therapy.

Discussion: This case highlights complications in the diagnosis of CVT in the setting of PDPH. Patients presenting with persistent headaches with confusion or motor weakness even after EBP may indicate a more concerning diagnosis of CVT.

References:

1) BJA 2010;84(3):407-10

2) NEJM 1996;335:768–774



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