This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kapessidou, Y. Articles by Boogaerts, J. G. Search for Related Content PubMed PubMed Citation Articles by Kapessidou, Y. Articles by Boogaerts, J. G.

Case report: Cerebral vein thrombosis after subarachnoid analgesia for labour

[Thrombose veineuse cérébrale à la suite d’une analgésie sous-arachnoïdienne pour le travail obstétrical]

Yota Kapessidou, MD^*, Mathieu Vokaer, MD, Marc Laureys, MD, Jean C. Bier, MD and Jean G. Boogaerts, MD PhD

^* From the Departments of Anesthesiology, CHU Brugmann Hospital, Brussels;
Neurology, CUB Erasme Hospital, Brussels;
Neuroradiology, CUB Erasme Hospital, Brussels; and
Anesthesiology, University Hospital Centre, Charleroi, Belgium.

Address correspondence to: Dr. Yota Kapessidou, Department of Anesthesiology, CHU Brugmann Hospital, 4 Place Van Gehuchten, 1020 Brussels, Belgium. Phone: +32-2-477-39-96; or +32-2-650-95-52; Fax: +32-2-477-33-45; E-mail: pkapessi{at}ulb.ac.be

Purpose: We report a case of sagittal sinus thrombosis occurring after spinal analgesia for labour to highlight the difficulty of such diagnosis in the presence of postpartum atypical headache following regional anesthesia/analgesia.

Clinical features: A previously healthy 21-yr-old, primiparous, preeclamptic parturient was admitted to the hospital at 37 weeks gestation for uterine contractions. Before pregnancy she was taking no medication other than oral contraceptives and was a non-smoker. Spinal analgesia was established on the first attempt at 8 cm of cervical dilation, in the setting of rapid progression of labour. Following an uneventful delivery, on the third day postpartum, the patient experienced gradual onset of an atypical headache with unclear postural character, followed by focal neurological signs five days later. Emergency neuroimaging revealed direct evidence of thrombosis in the posterior sagittal venous sinus. Anticoagulation was initiated with iv heparin (500 UI·kg^–1·day^–1). The patient’s headache decreased progressively and full motor recovery was noted by day 14 postpartum. After 24 days, the patient was discharged without any neurological disability. Common inherited thrombophilic dispositions were absent, with the exception of a decrease in protein S level.

Conclusion: Central venous thrombosis, while rare, is a recognized cause of puerperium stroke. The present case highlights the importance of considering the diagnosis in the presence of postpartum atypical headache following spinal anesthesia/analgesia. Early intervention with systemic heparinization is critical when the diagnosis is confirmed.