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Post-dural puncture posterior reversible encephalopathy syndrome.
Fauzia N Minai1, Syeda Fauzia Hasan, Mughis Sheerani
1Department of Anaesthesia, The Aga Khan University, Karachi. fauzia.minai@aku.edu
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
|February 1, 2011
Summary
A pregnant patient experienced severe neurological symptoms after an inadvertent dural puncture during cesarean delivery anesthesia. Prompt diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES) via MRI led to successful treatment, avoiding complications.
Area of Science:
- Neurology
- Obstetrics
- Anesthesiology
Background:
- Inadvertent dural puncture during combined spinal-epidural anesthesia for cesarean delivery can lead to complications.
- Postpartum neurological symptoms, including seizures, can mimic eclampsia or meningitis.
Purpose of the Study:
- To report a case of Posterior Reversible Encephalopathy Syndrome (PRES) following inadvertent dural puncture in a pregnant patient.
- To emphasize the importance of considering PRES in obstetric patients with neurological symptoms after dural puncture.
Main Methods:
- Case report of a 36-week pregnant patient undergoing cesarean section.
- Diagnosis of PRES confirmed by Magnetic Resonance Imaging (MRI) of the brain.
- Treatment with anticonvulsants and antibiotics.
Main Results:
- The patient developed occipital headache, neck pain, and generalized tonic-clonic seizures post-procedure.
- MRI revealed reversible ischemic changes characteristic of PRES.
- Neurological symptoms resolved completely with appropriate medical management.
Conclusions:
- PRES should be suspected in obstetric patients presenting with neurological symptoms after dural puncture, even if initially resembling post-dural puncture headache.
- Neuroradiology, particularly MRI, is crucial for diagnosing PRES.
- Misdiagnosis and inappropriate treatment, such as epidural blood patch, can be detrimental in PRES cases.
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