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Postgrad Med J doi:10.1136/pgmj.2010.111708
  • Images in medicine

Intracranial hypotension and venous sinus thrombosis: two postpartum headaches

  1. Mark O McCarron2
  1. 1Departments of Obstetrics and Gynaecology, Altnagelvin Area Hospital, Derry, Northern Ireland
  2. 2Department of Neurology, Altnagelvin Area Hospital, Derry, Northern Ireland
  1. Correspondence to Dr Mark McCarron MD, FRCP, Department of Neurology, Altnagelvin Hospital, Derry BT47 6SB, Northern Ireland; markmccarron{at}doctors.org.uk

Dural puncture from epidural anaesthesia can result in intracranial hypotension with postural headache. Intracranial hypotension and the puerperium have been associated with cerebral venous sinus thrombosis (CVST). We report a postpartum patient in whom neuroimaging demonstrated intracranial hypotension and CVST following epidural anaesthesia.

After an uncomplicated pregnancy, an 18-year-old primigravida delivered a live male infant at term via vacuum-assisted delivery and epidural anaesthesia. Within hours she developed a moderately severe diffuse postural headache, which was exacerbated by sitting upright. Over the following days, the headache intensified to 10 out of 10 in severity with associated nausea, vomiting and photophobia.

Despite having intravenous fluids, analgesia, caffeine and …

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