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British Journal of Anaesthesia, 2003, Vol. 90, No. 1 98-100
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch

M. Mercieri*,1, A. Mercieri2, S. Paolini3, R. Arcioni1, D. Lupoi4, F. Passarelli4, G. Pinto1 and D. Celleno4

1 Università di Roma ‘La Sapienza’, Ospedale S. Andrea, Rome, Italy. 2 Ospedale S. Isidoro, Trescore, Bergamo, Italy. 3 Ospedale S. Maria, Terni, Italy. 4 Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy Via Pavia 124, I-00161 Rome, Italy. E-mail: mamerx@yahoo.com

Puerperal women are reported to have a rate of cerebral infarction 13 times greater than non-pregnant females. We report a case of cerebral ischaemia in a 30-yr-old healthy parturient after epidural analgesia for labour, complicated by dural puncture treated with two epidural blood patches. Investigations showed the development of cerebral ischaemia on postpartum day 14. A transcranial Doppler ultrasonography showed vasospasm of the left middle cerebral artery still present at 3-month follow-up. At 1-yr follow-up, the patient had homonymous hemianopsia. We discuss the possible causative mechanism of the cerebral ischaemia in relation to the dural puncture and epidural blood patch.

Br J Anaesth 2003; 90: 98–100


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