A Case of Postpartum Headache Post Dural Puncture. Post Dural Puncture Headache or Reversible Cerebral Vasoconstriction Syndrome - Posterior Reversible Encephalopathy Syndrome?

Abstract BACKGROUNDReversible Cerebral Vasoconstriction Syndrome (RCVS) and Posterior Reversible Encephalopathy Syndrome (PRES) are two rare neurological conditions, clinically characterized of headache. This is sometimes difficult to differentiate from post dural puncture headache (PDPH). In our case a diagnosis of PDPH was made but imaging showed signs of RCVS-PRES. The novelty is that, unlike in cases reported in literature, no liquoral hypotension signs were detected on imaging.CASE PRESENTATIONWe present a case of RCVS-PRES in a postpartum woman that presented headache as first symptom, and only later experienced seizures. Epidural analgesia was performed during labour, and it was complicated by dural puncture that worked as a confounding factor in the clinical postpartum evaluation. Seizures represented an unexpected event in the course of treating this patient for post dural puncture headache.CONCLUSIONSWe point out the attention on changes of clinical characteristics of headache as an important factor to be analyzed, in order to have a prompt diagnosis. Moreover, we evaluate possible triggers of RCVS and PRES; in our case dural puncture is probably not the trigger, in fact there were no liquoral hypotension signs on imaging. According to literature reports, puerperium itself was a promoting factor.