“A case of postpartum headache post dural puncture. Post Dural Puncture Headache or Reversible Cerebral Vasoconstriction Syndrome - Posterior Reversible Encephalopathy Syndrome?”

Abstract

Background and aim: Reversible Cerebral Vasoconstriction Syndrome (RCVS) and Posterior Reversible Encephalopathy Syndrome (PRES) are two rare neurological conditions, clinically characterized by headache. In our case a diagnosis of PDPH was made though imaging showed signs of RCVS-PRES. Methods: We present a case of RCVS-PRES in a postpartum woman who presented headache as first symptom and only later experienced seizures. Dural puncture worked as a confounding factor in the clinical postpartum evaluation. Results-Conclusions: We want to focus the attention on changes of clinical characteristics of headache as an important factor to be analysed, in order to have a prompt diagnosis. We therefore propose a diagnostic algorithm. 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.