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110 Early onset of Post-Dural Puncture Headache (PDPH) and meningeal signs following urgent caesarian section. A case report
  1. E Nikouli,
  2. G Karras and
  3. B Kiamiloglou
  1. ’Sismanogleion’ General Hospital of Komotini, Komotini, Greece


Background and Aims 19-year-old parturient, ASA II, presented for the first time in the Ob/Gyn ER, reporting intense uterine contractions, multiparous (2 previous caesarian sections), 3 days of nausea and vomit, without fever, heavy smoker, and recent food uptake.

Methods Following the first ER screening the parturient underwent spinal anaesthesia (sitting position, 25G Quincke non-traumatic needle, first try, 12 mg chirocaine and 0.0 mg fentanyl). Intraprocedural vomiting, lowered BP, and dizziness were observed. The caesarian section was performed uneventfully.

Results 14h after the woman’s re-admission, worsening headache even in prone position, nausea, tinnitus and photophobia were reported. Meningeal signs followed 24h p/o. Lab tests were repeated. Blood culture, cerebral CT scan, pupilloscopy and antibiotic prophylaxis were prescribed because meningitis was suspected. There was no suspicion of an early onset of PDPH despite CT-confirmed signs of intracranial hypotension. The woman was transferred to the nearest university hospital. Neurologists diagnosed iatrogenic PDPH due to intense intracranial hypotension confirmed by cerebral CT and MRI and by excluding bacterial infection (negative blood cultures, CSF testing), and treated the patient accordingly. The continuous supine position of the woman – incompatible with a rapidly worsening PDPH – and our belief in adequate anaesthetic technique, lead us to perform PCR on the remaining blood samples for viral infection markers and they came back positive with EBV infection.

Conclusions Neurologists’ early conclusion of iatrogenic PDPH, CT images and early onset of symptoms, were in contrast with the adequate anaesthetic technique. That covered the true cause of the patient’s worsening situation: meningeal irritation due to EBV infection.

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