Abstract
A previously healthy primiparous 29-year-old woman, presented at 35-weeks’ gestation with a 12-day history of postural headache. There was no previous headache history and no preceding trauma or lumbar puncture. The pregnancy was uncomplicated. Initial MRI-B was interpreted as normal. Due to persistent and debilitating headache, MRI-B was repeated 2-weeks later and demonstrated profound features of intracranial hypotension. MRI-spine showed epidural collections at cervical and thoracic levels. Conservative management was initiated, followed by sphenopalatine ganglion nerve block, with no significant improvement. An epidural blood patch at 36-weeks’ gestation provided only transient benefit. Normal vaginal delivery occurred at 39+4 weeks with persisting headache symptoms and a second blood patch 1-week post-partum provided permanent headache resolution.
SIH due to cerebrospinal fluid (CSF) leak is characterised by low CSF pressure, postural headache, and characteristic radiological findings. Aetiology and incidence in pregnancy is unknown. Occurrence in early-mid pregnancy is favoured in case reports.1 2 Pain is challenging to manage due to limitations on analgesic use in pregnancy. The potential risks of a vaginal delivery and/or administration of epidural analgesia are unknown, and the likelihood of recurrence during future pregnancies remains uncertain.
This case highlights the poorly understood aetiology of SIH during pregnancy, and the unique management challenges it presents.
References
Asakura H, Hayashi Z, Seto M, Araki T. Spontaneous intracranial hypotension during pregnancy. Obstet Gynecol. 2001;97:804–805. doi: 10.1016/S0029-7844(00)01211-4.
McGrath E, Monaghan T, Alexander M, Hennessy M. Recurrent spontaneous intracranial hypotension in early pregnancy. BMJ Case Reports. 2010. doi:10.1136/bcr.05.2010.3040.
