Iatrogenic acute headache secondary to co-administration of ergometrine and phenylephrine during cesarean section: a case report

Abstract

Background Reversible cerebral vasoconstriction syndrome has been described as a syndrome of severe recurrent thunderclap headache in bilateral posterior, with or without other neurological symptoms and signs, is fully reversible by 3 months. Vasoconstrictor play an important role in the development of reversible cerebral vasoconstriction syndrome. Case presentation A 37-year-old pregnant women underwent elective cesarean section at 36+6 weeks gestation under combined spinal-epidural anesthesia . After a healthy female neonate was delivered, 0.2mg ergometrine was injected intramuscularly to induce uterine contraction. 30 minutes later, 0.1mg phenylephrine was given intravenously to treatment hypotension. Then she complained of a sudden headache and blood pressure was significantly risen to 163/104 mmHg versus baseline was 118/76 mmHg. Her severe headache was relieved 2 hrs after administering nitroglycerin, and headache did not recur after discontinued nitroglycerin. Conclusion The reason of hypotension should be identified in patients received ergometrine during cesarean section. Phenylephrine or other sympathomimetic should be used cautiously and vital signs should be observed closely for patient who received ergometrine during cesarean section. Nitroglycerin may be an alternative for the treatment of severe headache in reversible cerebral vasoconstriction syndrome.