Posterior Reversible Encephalopathy Syndrome with Vasospasm in a Postpartum Woman After Postdural Puncture Headache Following Spinal Anesthesia

Abstract

We describe a postpartum woman who, after an uneventful pregnancy, developed posterior reversible encephalopathy syndrome after spinal anesthesia, complicated by postdural puncture headache.

Overlapping Features of Eclampsia and Postpartum Angiopathy

“…The results of our literature review [6,7,9,11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] are summarized in Table 3. A recent review by Williams et al [9] described 45 patients with PPA, although only 27 had ''spontaneous'' PPA, as defined by the absence of exposure to sympathomimetics or vasoactive medications.…”

Drug-Induced Encephalopathy

“…Morphine has been described as having induced an encephalopathy characterized by a myoclonus, motor dysfunction, or vertigo (Goundrey, 1990;Kakinohana et al, 2003). Spinal anaesthesia with hyperbaric bupivacaine lead to an encephalopathy that developed a few days after the drug's administration (Ho & Chan, 2007). A drug abuse-evoked encephalopathy was also reported after ketamine and gamma hydroxybutyrate (Virmani et al, 2010).…”

What’s new in obstetric anesthesia

“…The purported mechanism of PRES includes endothelial dysfunction, acute increases in blood pressure that may exceed the upper limit of cerebral autoregulation, and vasogenic edema. A number of publications have reported PRES in the peripartum period, some of which, 35,36 but not all, [37][38][39][40] noting an association with preeclampsia. Two cases of PRES have occurred in the presence of postdural puncture headache, which complicates the recognition and management of the disease.…”

“…Two cases of PRES have occurred in the presence of postdural puncture headache, which complicates the recognition and management of the disease. 36,40 The prompt diagnosis of PRES is critical for early management of hypertensive encephalopathy and to prevent subsequent irreversible white matter lesions of the brain. Dyer et al 41 emphasized the important role that anesthesiologists play in the management of these sick women, particularly in regards to regulating the hemodynamic and cardiovascular effects of neuraxial anesthesia during cesarean delivery.…”