[Unknown intracerebral tumour presenting as brainstem compression following unintentional dural puncture].

Abstract

A 36-year old primigravid of 41 weeks gestation was admitted to the labour ward. Her past medical history included hyperemesis gravidarum and migraine. An accidental dural puncture occurred during labour epidural analgesia. In the postpartum period she presented with continuous headache, and was treated with oral analgesics, oral caffeine, fluid therapy, and tetracosactide. She refused an epidural blood patch. On the seventh day postpartum, the patient was re-admitted to the Emergency Department with decreased level of consciousness and signs of brainstem compression. Cranial computed tomography and magnetic resonance imaging showed a posterior fossa tumour. An emergency craniotomy was performed with complete neurological recovery. This case emphasises the need to consider the differential diagnoses of post-dural puncture headache and to highlight the warning signs in patients who do not respond despite treatment with conventional therapy.

• Authors: J Castro-Castro, O Figueiredo-González, A Río-Gómez, N Carballo-Loureiro, D Castro-Bouzas
• Journal: Revista espanola de anestesiologia y reanimacion (Rev Esp Anestesiol Reanim) 2014 Aug-Sep Vol. 61 Issue 7 Pg. 392-5 ISSN: 2340-3284 [Electronic] Spain
• Vernacular Title: Tumor cerebral no conocido que se presenta con compresión del tronco cerebral tras punción dural accidental.
• PMID: 24041454 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Topics

• Accidents
• Adult
• Analgesia, Epidural (adverse effects)
• Analgesia, Obstetrical (adverse effects)
• Brain Stem (physiopathology)
• Consciousness Disorders (etiology)
• Decompressive Craniectomy
• Diagnosis, Differential
• Dura Mater (injuries)
• Encephalocele (etiology)
• Female
• Headache (etiology)
• Humans
• Infratentorial Neoplasms (complications, diagnosis, surgery)
• Neoplasms, Unknown Primary (complications, diagnosis, surgery)
• Neurilemmoma (complications, diagnosis, surgery)
• Neuroimaging
• Post-Dural Puncture Headache (diagnosis)
• Pregnancy
• Pressure (adverse effects)
• Puerperal Disorders (diagnosis, etiology)
• Punctures (adverse effects)