The aim of this study is to report the first case of simultaneous appearance of cerebral
venous thrombosis (CVT) and bilateral
subdural hematomas (SDHs) following
epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum
headache. A 26-year old primigravida with a history of
epilepsy received
epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the
headache. Patient responded very well to the
pain medication and oral hydration, and the
headache was relieved. Ten days after the delivery, the
headache reoccurred, and an
epidural blood patch was performed that successfully relieved her symptom. Stronger progressive
headache with
nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with
low molecular weight heparin and antiaggregation
therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (
epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate
therapy could be life-threatening.