Cerebral venous sinus thrombosis after regional anesthesia in a patient with severe preeclampsia - a diagnostic challenge

Abstract

Venous sinus thrombosis is a rare entity, usually associated with coagulation disorders, inflammatory diseases, trauma, infection, pregnancy and the postpartum period. The most common symptom is headache and without treatment this condition can be fatal. In our case a patient with preeclampsia was initially treated for post-dural puncture headache after spinal anesthesia for cesarean section. After the headache worsened a cerebral venous sinus thrombosis (CVST) was diagnosed. There are several causes of postpartum headache and venous sinus thrombosis is not among the most frequent. Diagnosis can be challenging especially if neuraxial anesthesia was used or in cases of preeclampsia, two of the leading causes of headache in the postpartum period. This report emphasizes the importance of a careful differential diagnosis of headache in the postpartum during the treatment of persistent post-dural puncture headache.