RESUMO
Se trata de una primigrávida de 36 años de edad en su semana 41 de gestación con antecedentes de hiperemesis gravídica. Durante la analgesia epidural se produjo una punción dural accidental. En el posparto presentó cefalea persistente, tratada mediante analgésicos orales, cafeína, fluidoterapia y tetracosáctido, rechazando el parche hemático epidural. En el séptimo día posparto la paciente reingresó en el Servicio de Urgencias con deterioro del nivel de conciencia y datos de compresión del tronco cerebral. La tomografía computarizada y la resonancia magnética craneales mostraron un tumor de fosa posterior. Se realizó una craneotomía con carácter de urgencia, con recuperación neurológica completa. Resaltamos la importancia del diagnóstico diferencial de la cefalea pospunción dural y destacamos los signos de alarma ante los pacientes que no responden a los tratamientos convencionales (AU)
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 (AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/tratamento farmacológico , Anestesia Epidural/instrumentação , Anestesia Epidural/métodos , Anestesia Epidural , Hidratação , Anestesia Epidural/tendências , Cefaleia/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Diagnóstico Diferencial , Bupivacaína/uso terapêutico , Fentanila/uso terapêuticoRESUMO
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.
