Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch

• Published in: British journal of anaesthesia : BJA Vol. 90; no. 1; pp. 98 - 100
• Main Authors: Mercieri, M., Mercieri, A., Paolini, S., Arcioni, R., Lupoi, D., Passarelli, F., Pinto, G., Celleno, D.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.01.2003; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; analgesia; Analgesia, Epidural - adverse effects; analgesia, obstetric; Analgesia, Obstetrical - adverse effects; Biological and medical sciences; Blood Patch, Epidural - adverse effects; brain; Brain Ischemia - etiology; brain, cerebral ischaemia; cerebral ischaemia; complications; complications, dural puncture; Delivery. Postpartum. Lactation; Disorders; Dura Mater - injuries; dural puncture; Female; Gynecology. Andrology. Obstetrics; Headache Disorders - etiology; Humans; Medical sciences; Neurology; obstetric; Pregnancy; Puerperal Disorders - etiology; Vascular diseases and vascular malformations of the nervous system; Wounds, Penetrating - complications; brain, cerebral ischaemia; analgesia, obstetric; complications, dural puncture; analgesia, obstetric; brain, cerebral ischaemia; complications, dural puncture; Headache; Epidural blood patch; Cardiovascular disease; Labor; Vascular disease; Pain; Ischemia; Complication; Female; Neurological disorder; Cerebrovascular disease; Human; Nervous system diseases; Stroke; Puerperium; Cerebral disorder; Case study; Pregnancy; Analgesia; Extradural administration; Central nervous system disease; Brain (vertebrata)
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aeg021

Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14. A transcranial Doppler ultrasonography showed vasospasm of the left middle cerebral artery still present at 3-month follow-up. At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.