33-year-old woman with severe postpartum headache

ABSTRACT

Patient was a 33-year-old woman underwent her first time cesarean section combined with spinal epidural anesthesia 5 days before and discharged the day after with good condition. She got severe headache with pain score about 8-9, 2 days after discharge from hospital. Her headache was severe, bilateral, pulsatile and almost likely sudden onset accompanied with nausea that mildly progressed after starting. She went to the hospital, which her delivery was taken; with impression of Post Dural Puncture Headache [PDPH] 10mg IV morphine sulfate was administered totally and subsequently discharged home with relative decreased headache. The day after first headache attack, when she admitted in our Hospital, claimed that could not hold her baby for breast-feeding. In minimental status examination, time disorientation was obvious but orientation to place and person was intact. In motor examination, we found right side hemiparesis and decreased right upper and lower limbs tone. Brain computed tomography [CT] scan and magnetic resonance imaging [MRI] revealed a massive cortico-subcortical hemorrhagic infarction on left parieto-occipital lobes. With attention to significant nonhomogeneous occupying lesion, brain MRI with gadolinium and magnetic resonance venography [MRV] were performed