Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture

• Published in: Revista española de anestesiología y reanimación Vol. 61; no. 7; p. 392
• Main Authors: Castro-Castro, J, Figueiredo-González, O, Río-Gómez, A, Carballo-Loureiro, N, Castro-Bouzas, D
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.08.2014
• Subjects: Accidents; Adult; Analgesia, Epidural - adverse effects; Analgesia, Obstetrical - adverse effects; Brain Stem - physiopathology; Consciousness Disorders - etiology; Decompressive Craniectomy; Diagnosis, Differential; Dura Mater - injuries; Encephalocele - etiology; Female; Headache - etiology; Humans; Infratentorial Neoplasms - complications; Infratentorial Neoplasms - diagnosis; Infratentorial Neoplasms - surgery; Neoplasms, Unknown Primary - complications; Neoplasms, Unknown Primary - diagnosis; Neoplasms, Unknown Primary - surgery; Neurilemmoma - complications; Neurilemmoma - diagnosis; Neurilemmoma - surgery; Neuroimaging; Post-Dural Puncture Headache - diagnosis; Pregnancy; Pressure - adverse effects; Puerperal Disorders - diagnosis; Puerperal Disorders - etiology; Punctures - adverse effects; Dural puncture; Headache; Brain tumour; Analgesia epidural; Tumor cerebral; Parto; Labour; Punción dural; Cefalea; Epidural analgesia
• ISSN: 2340-3284
• DOI: 10.1016/j.redar.2013.06.012

A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.