Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report
Abstract Background Parturients are prone to postdural puncture headache (PDPH) after epidural puncture. Cerebral venous sinus thrombosis (CVST) is a fatal complication of PDPH. The main symptom of both is headache, however, the mechanism is not similar. For persistent PDPH, early differential diagn...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02418-8 |
| _version_ | 1797276373693235200 |
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| author | Pei Wang Xia Zhou Fang Sheng Xiaolong Wang Caifeng Shi Wei Feng |
| author_facet | Pei Wang Xia Zhou Fang Sheng Xiaolong Wang Caifeng Shi Wei Feng |
| author_sort | Pei Wang |
| collection | DOAJ |
| description | Abstract Background Parturients are prone to postdural puncture headache (PDPH) after epidural puncture. Cerebral venous sinus thrombosis (CVST) is a fatal complication of PDPH. The main symptom of both is headache, however, the mechanism is not similar. For persistent PDPH, early differential diagnosis from CVST is essential. Optic nerve sheath diameter (ONSD) measurements can be used to identify changes in intracranial pressure as an auxiliary tool to distinguish the cause of headache. Case presentation The dura of a 32-year-old woman undergoing cesarean section was accidentally penetrated while administering epidural anesthesia, and the patient developed PDPH the subsequent day. The patient refused epidural blood patch (EBP) treatment and was discharged after conservative treatment. Fourteen days post-discharge, she was readmitted for a seizure. Magnetic resonance imaging (MRI) and Magnetic resonance angiography (MRA) indicated low cranial pressure syndrome and superior sagittal sinus thrombosis with acute infarction. The next morning, the EBP was performed with 15 ml autologous blood. Subsequently, the headache symptoms decreased during the day and worsened at night. ONSD measurement suggested dilation of the optic nerve sheath, and subsequently, the patient showed intracranial hypertension with papilledema. After dehydration and anticoagulant treatment, the patient’s symptoms were relieved and she was discharged from the hospital 49 days later. Conclusions Headache is the main symptom of PDPH and cerebral venous thrombosis, which are difficult to distinguish. ONSD measurement may help to estimate the intracranial pressure, and early measurement may be helpful for women with PDPH to avoid serious complications, such as CVST. |
| first_indexed | 2024-03-07T15:27:21Z |
| format | Article |
| id | doaj.art-fe70d5a13fa04b29b34fa2507f108ab2 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-07T15:27:21Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-fe70d5a13fa04b29b34fa2507f108ab22024-03-05T16:40:21ZengBMCBMC Anesthesiology1471-22532024-01-012411510.1186/s12871-024-02418-8Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case reportPei Wang0Xia Zhou1Fang Sheng2Xiaolong Wang3Caifeng Shi4Wei Feng5Department of Anesthesiology, The Affiliated Hospital of Qingdao UniversityDepartment of Anesthesiology, The Affiliated Hospital of Qingdao UniversityDepartment of Anesthesiology, The Affiliated Hospital of Qingdao UniversityDepartment of Emergency surgery, The Affiliated Hospital of Qingdao UniversityDepartment of Anesthesiology, The Affiliated Hospital of Qingdao UniversityDepartment of Anesthesiology, The Affiliated Hospital of Qingdao UniversityAbstract Background Parturients are prone to postdural puncture headache (PDPH) after epidural puncture. Cerebral venous sinus thrombosis (CVST) is a fatal complication of PDPH. The main symptom of both is headache, however, the mechanism is not similar. For persistent PDPH, early differential diagnosis from CVST is essential. Optic nerve sheath diameter (ONSD) measurements can be used to identify changes in intracranial pressure as an auxiliary tool to distinguish the cause of headache. Case presentation The dura of a 32-year-old woman undergoing cesarean section was accidentally penetrated while administering epidural anesthesia, and the patient developed PDPH the subsequent day. The patient refused epidural blood patch (EBP) treatment and was discharged after conservative treatment. Fourteen days post-discharge, she was readmitted for a seizure. Magnetic resonance imaging (MRI) and Magnetic resonance angiography (MRA) indicated low cranial pressure syndrome and superior sagittal sinus thrombosis with acute infarction. The next morning, the EBP was performed with 15 ml autologous blood. Subsequently, the headache symptoms decreased during the day and worsened at night. ONSD measurement suggested dilation of the optic nerve sheath, and subsequently, the patient showed intracranial hypertension with papilledema. After dehydration and anticoagulant treatment, the patient’s symptoms were relieved and she was discharged from the hospital 49 days later. Conclusions Headache is the main symptom of PDPH and cerebral venous thrombosis, which are difficult to distinguish. ONSD measurement may help to estimate the intracranial pressure, and early measurement may be helpful for women with PDPH to avoid serious complications, such as CVST.https://doi.org/10.1186/s12871-024-02418-8Cerebral venous thrombosisPostdural puncture headacheOptic nerve sheath diameterCesarean section |
| spellingShingle | Pei Wang Xia Zhou Fang Sheng Xiaolong Wang Caifeng Shi Wei Feng Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report BMC Anesthesiology Cerebral venous thrombosis Postdural puncture headache Optic nerve sheath diameter Cesarean section |
| title | Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report |
| title_full | Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report |
| title_fullStr | Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report |
| title_full_unstemmed | Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report |
| title_short | Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report |
| title_sort | ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section a case report |
| topic | Cerebral venous thrombosis Postdural puncture headache Optic nerve sheath diameter Cesarean section |
| url | https://doi.org/10.1186/s12871-024-02418-8 |
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