Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch.

Mercieri, M; Mercieri, A; Paolini, S; Arcioni, R; Lupoi, D; Passarelli, F; Pinto, G; Celleno, D · Br J Anaesth · 2003

case_report · Level V

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Abstract

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.

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