How to differentiate the headache of Cerebral Venous Thrombo
Case report
A 33-year-old male patient, American Society of Anesthesiologists physical status 1, underwent fissurectomy under spinal anaesthesia with a 25-gauge Quincke spinal needle (BD, Becton Dickinson S. A), in a single attempt. His post-operative period was uneventful, and he was discharged the next day. The patient returned on the fifth post-operative day with complaints of headache, which had started on the second post-operative day. The headache was present all over the head and was not associated with nausea, vomiting or any other neurological signs. It increased in intensity on assuming erect posture and was relieved on assuming supine position.

A diagnosis of PDPH was made, and AEBP was planned in the operation theatre. In the theatre, after establishing standard monitors, under all aseptic precautions and patient in lateral position, epidural space (at L 2 -L 3 ) was identified with loss of resistance to air. Autologous blood (20 ml) was drawn aseptically from the left cephalic vein and was injected into epidural space after confirming negative aspiration. At the end of the epidural injection, the patient became apnoeic and unresponsive. Immediately, the position of the patient was changed supine and bag-mask ventilation was initiated. Within minutes, he became fully conscious and responsive, with no neurological deficit.

On evaluation over the next 24 h, it was found that the patient had only partial relief of headache. Next day, his headache increased in intensity and was orthostatic in nature. Although he had no other neurological symptoms, due to the transient unresponsiveness that followed the first AEBP, we did not attempt a second AEBP and decided to evaluate him with magnetic resonance imaging (MRI) of the brain.


http://www.ijaweb.org/article.asp?issn=0019-5049;year=2016;volume=60;issue=5;spage=352;epage=354;aulast=Sherfudeen
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