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Case Report
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| Stroke after blood patch in a patient with postpartum angiopathy and posterior reversible encephalopathy syndrome | ||||||
| Sergio Alejandro Sánchez-Luna1,2, Amanda L. Jagolino3, Manuel Núñez4, Juan Pablo Sánchez-Luna5, Gustavo Andres Ortiz6 | ||||||
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1Internal Medicine Resident Physician, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
2Internal Medicine Resident Physician, Department of Internal Medicine, Iowa City Veterans Administration Medical Center (VAMC), Iowa City, Iowa, USA. 3Faculty Physician, Department of Neurology, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA. 4Faculty Physician, División de Neurología, Hospital Municipal de Surco, Santiago de Surco. 5Internal Medicine Resident Physician, División de Medicina Interna, Hospital ángeles del Pedregal, Ciudad de México, México. 6Faculty Physician, Department of Neurology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA. | ||||||
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| How to cite this article |
| Sánchez-Luna SA, Jagolino AL, Núñez M, Sánchez-Luna JP, Ortiz GA. Stroke after blood patch in a patient with postpartum angiopathy and posterior reversible encephalopathy syndrome. Int J Case Rep Images 2016;7(11):696–700. |
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Abstract
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Introduction:
The peripartum period is associated with physiological changes that increase the risk of both ischemic and hemorrhagic stroke. The incidence and risk of stroke attributed to pregnancy vary among studies, with up to 210 strokes per 100,000 deliveries. Our objective is to increase awareness of possible cerebrovascular complications with the use of blood patch treatments.
Case Report: We report a case of a 37-year-old postpartum female who developed worsening cerebral vasospasm and acute ischemic stroke immediately after receiving an autologous epidural blood patch for post-lumbar puncture (LP) headache. This occurred in the setting of postpartum vasculopathy, including both posterior reversible encephalopathy syndrome (PRES) and postpartum angiopathy (PPA). After treatment with nimodipine, a calcium channel blocker (CCB), there was radiological improvement of the severe vasospasm. Patient remained clinically stable with eventual resolution of postpartum vasculopathy, with no new complications for two years of follow-up. Conclusion: For patients with predisposing risk factors for stroke, the vasomotor effects of epidural blood patch may decrease a threshold for an ischemic event to occur. | |
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Keywords:
Epidural blood patch, Posterior reversible encephalopathy syndrome (PRES), Post-lumbar puncture headache, Stroke
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Author Contributions
Sergio Alejandro Sánchez-Luna – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Amanda L. Jagolino – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Manuel Núñez – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published Juan Pablo Sánchez-Luna – Substantial contribution to acquisition of data, Drafting the article, Final approval of the version to be published Gustavo Andres Ortiz – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Sergio Alejandro Sánchez-Luna et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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