naa a22 4500 510743609 CHVBK 20180411083037.0 cr unu---uuuuu 180411e20130301xx s 000 0 eng 10.1007/s12630-012-9846-x doi (NATIONALLICENCE)springer-10.1007/s12630-012-9846-x Postpartum workup of postdural puncture headache leads to diagnosis and surgical treatment of thoracic pseudomeningocele: a case report [Elektronische Daten] [Lindsay Hurlburt, Christine Lay, Michael Fehlings, Jose Carvalho] Une investigation postpartum de céphalées post-ponction durale débouche sur le diagnostic et le traitement chirurgical d'un pseudoméningocèle thoracique: une présentation de cas Purpose: Postdural puncture headache is a well-known complication of neuraxial anesthesia in childbirth. There are, however, many other causes of postpartum headache, some of which may present like postdural puncture headache and confuse the diagnosis. We report a case of postpartum headache due to pseudomeningocele. Clinical features: A 31-yr-old primigravida presented at 35weeks gestation for induction of labour. A pre-pregnancy history of migraines was suspicious for low cerebrospinal fluid headache, but this had been ruled out by normal brain magnetic resonance imaging (MRI), and the headaches had resolved with pregnancy. A labour epidural was easily placed at L3/4. On postpartum day one the patient complained of mild headache, and the severe pre-pregnancy headache returned within weeks. The pounding occipital/hemispheric headache was associated with nausea and vomiting; it worsened over the day, and improved when the patient was supine. A repeat brain MRI showed evidence of intracranial hypotension, and an epidural blood patch was performed at L3/L4 with no improvement. A second blood patch was performed ten days later, still with no improvement. A subsequent brain MRI showed unchanged intracranial hypotension, and a spine MRI revealed a pseudomeningocele at T7. A computed tomography myelogram confirmed a T7/8 pseudomeningocele. The patient underwent direct microsurgical exploration and repair four months later, which was followed by re-operation ten months later. The patient's condition has since remained significantly improved. Discussion: This case highlights the importance of maintaining a wide differential in the workup of postpartum headache after regional anesthesia, particularly in cases refractory to blood patch. This case also reveals a T7 pseudomeningocele causing spontaneous intracranial hypotension that otherwise may not have been detected and corrected. Canadian Anesthesiologists' Society, 2012 Hurlburt Lindsay Department of Anesthesia, University of Toronto, Toronto, ON, Canada aut Lay Christine Department of Neurology, Women's College Hospital, University of Toronto, Toronto, ON, Canada aut Fehlings Michael Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada aut Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue Room 781, M5G 1X5, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 294-298 0832-610X 60:3<294 2013 60 12630 https://doi.org/10.1007/s12630-012-9846-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-012-9846-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hurlburt Lindsay Department of Anesthesia, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Lay Christine Department of Neurology, Women's College Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Fehlings Michael Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 294-298 0832-610X 60:3<294 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer