Abstract
We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.
Keywords:
CSE; Combined spinal-epidural; Dural puncture; Epidural; Paradoxical postdural puncture headache; Spinal headache.
Copyright © 2016. Published by Elsevier Inc.
MeSH terms
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Acetaminophen / therapeutic use
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Adult
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Analgesics, Opioid / administration & dosage
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Anesthesia, Epidural / adverse effects*
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Anesthesia, Obstetrical / adverse effects*
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Anesthesia, Spinal / adverse effects*
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Anesthetics, Local / administration & dosage
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Bupivacaine / administration & dosage
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Cerebrospinal Fluid Leak / complications*
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Delivery, Obstetric / adverse effects
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Drug Combinations
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Female
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Fentanyl / administration & dosage
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Humans
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Hypertension / drug therapy
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Hypertension / etiology
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Ketorolac / therapeutic use
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Labetalol / therapeutic use
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Needles
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Ondansetron / therapeutic use
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Oxycodone / therapeutic use
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Post-Dural Puncture Headache / diagnosis*
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Post-Dural Puncture Headache / drug therapy
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Post-Dural Puncture Headache / etiology
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Pregnancy
Substances
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Analgesics, Opioid
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Anesthetics, Local
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Drug Combinations
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oxycodone-acetaminophen
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Acetaminophen
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Ondansetron
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Oxycodone
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Labetalol
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Fentanyl
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Bupivacaine
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Ketorolac