Background

Cerebral venous sinus thrombosis (CVST) is a rare and life-threatening complication following delivery 

Early stages of CVST may mimic PDPH

Unintentional dural puncture (UDP) increases the risk of CVST

We present a case of UDP with acute PDPH followed by subacute CVST

 

Case

PPD 0- Unintentional dural puncture

PPD 1- Positional headache (HA) à PDPH

Epidural blood patch performed. HA resolution

PPD 9- Presented to ED with recurring HA, desired conservative management, discharged with Fiorcet

PPD 11- Returned to ED with worsening HA, mental status changes, and new neurologic deficits

CT venogram- extensive CVST

Therapeutic anticoagulation and neuro ICU

PPD 25- Discharged to inpatient rehab with near-baseline return of function

 

Teaching Points

Heightened vigilance in obstetric patients with unintentional dural puncture

Early neuroimaging in atypical/refractory cases

Dural puncture alters CSF dynamics

Cerebral venous dilation and stasis of CSF flow

Post Dural Puncture Headache	Cerebral Venous Sinus Thrombosis
Classic positional component	Absent or atypical positional component
24-72 hours onset	Days to weeks onset
Focal deficits rare	Commonly seizures, focal deficits, AMS, papilledema
Conservative management à epidural blood patch	Therapeutic anticoagulation