Cortical vein thrombosis as a possible cause of headache after epidural anesthesia: a case report
No Thumbnail Available
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Kortikālo vēnu tromboze ir reta un nopietna komplikācija pēc epidurālās anestēzijas procedūras. Lielākā daļa gadījumu ir saistīta ar predisponējošiem faktoriem, piemēram, grūtniecība, onkoloģiskas saslimšanas, orālo kontraceptīvo medikamentu lietošana, traumas. Tikai daži klīnisko gadījumu apraksti ir pieejami par kortikālo vēnu trombozi pēc epidurālās anestēzijas, kur biežākā klīniskā izpausme ir spēcīgas ortostātiskas galvassāpes.
Klīniskais gadījums: 36 gadus jauna paciente tiek stacionēta Paula Stradiņa klīniskās universitātes slimnīcas neiroloģijas nodaļā sakarā ar sūdzībām par spēcīgām galvassāpēm. Pacientei mēnesi atpakaļ tika veikta epidurālā anestēzija sakarā ar spēcīgām muguras sāpēm. Nākošajā dienā paciente sūdzējās par spēcīgām ortostātiskām galvassāpēm, kas progresēja 2 nedēļas, līdz guļus stāvoklim un masīvai pretsāpju terapijai vairs nebija efekta. Magnētiskajā rezonansē tika noteikta kortikālās vēnas tromboze labajā paura daivā gyrus precentralis. Pacientei tika uzsākta antikoagulantu terapija ar rivaroksabānu, kā rezultātā galvassāpes mazinājās. Pēc 4 mēnešiem paciente tika atkārtoti stacionēta slimnīcā ar sūdzībām par spēcīgām galvassāpēm un reiboni, kas mazinājās pēc antikoagulantu un pretsāpju medikamentu terapijas. Terapija tika turpināta 6 mēnešus pēc pacientes izrakstīšanās no slimnīcas. Galvassāpju stiprums ievērojami mazinājās, taču pilnīga simptomu novēršana netika sasniegta.
Šis klīniskais gadījums ir piemērs kortikālo vēnu trombozei kā komplikācijai pēc epidurālās anestēzijas. Diagnoze tika noteikta, balstoties uz MR atradni un klīniskajām izpausmēm. Kortikālo vēnu tromboze ir jāapsver kā iespējamā diagnoze visiem pacientiem, kam tika veikta epidurālā anestēzija. Agrīna diagnostika ir būtiska ātrai sāpju kupēšanai un pacienta labvēlīgam atveseļošanās procesam.
Cortical vein thrombosis is a rare and serious complication after epidural anesthesia. Most cases are related to predisposing factors, such as, pregnancy, malignancies, trauma, oral contraceptive use. Only few cases of cortical vein thrombosis after epidural anesthesia are described in the literature where the most common clinical manifestation is intense orthostatic headache. Case: A 36-year-old female was admitted to the Department of Neurology of Pauls Stradins Clinical University hospital with complaints of a strong headache. A month before the patient received epidural anesthesia due to a severe back pain. The next day the patient complained of a strong orthostatic headache which progressed for 2 weeks until supine position and massive pain management therapy did not relieve the patient’s symptoms. MRI revealed cortical vein thrombosis in the right parietal lobe, precentral gyrus. Anticoagulant therapy with rivaroxaban was initiated after which the headache reduced. After 4 months patient was repeatedly admitted to the hospital with complaints of severe headache and vertigo which reduced after anticoagulant and pain management therapy. The therapy was continued for 6 months after the patient was discharged. The severity of the headache was significantly reduced, however complete recovery was not achieved. This case shows an example of cortical vein thrombosis as a complication of epidural anesthesia. Diagnosis was based on clinical manifestation and MRI findings. Cortical vein thrombosis should be considered in all patients who underwent epidural anesthesia. Early diagnosis is significant for a fast pain management and recovery.
Cortical vein thrombosis is a rare and serious complication after epidural anesthesia. Most cases are related to predisposing factors, such as, pregnancy, malignancies, trauma, oral contraceptive use. Only few cases of cortical vein thrombosis after epidural anesthesia are described in the literature where the most common clinical manifestation is intense orthostatic headache. Case: A 36-year-old female was admitted to the Department of Neurology of Pauls Stradins Clinical University hospital with complaints of a strong headache. A month before the patient received epidural anesthesia due to a severe back pain. The next day the patient complained of a strong orthostatic headache which progressed for 2 weeks until supine position and massive pain management therapy did not relieve the patient’s symptoms. MRI revealed cortical vein thrombosis in the right parietal lobe, precentral gyrus. Anticoagulant therapy with rivaroxaban was initiated after which the headache reduced. After 4 months patient was repeatedly admitted to the hospital with complaints of severe headache and vertigo which reduced after anticoagulant and pain management therapy. The therapy was continued for 6 months after the patient was discharged. The severity of the headache was significantly reduced, however complete recovery was not achieved. This case shows an example of cortical vein thrombosis as a complication of epidural anesthesia. Diagnosis was based on clinical manifestation and MRI findings. Cortical vein thrombosis should be considered in all patients who underwent epidural anesthesia. Early diagnosis is significant for a fast pain management and recovery.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
kortikālo vēnu tromboze epidurālā anestēzija galvassāpes, cortical vein thrombosis epidural anesthesia headache