A case of late postpartum seizures after epidural analgesia

Seizures in the early post-partum period: A diagnostic dilemma

We discuss the differential diagnosis and management of early post-partum seizures and headache following a presumed dural puncture in a 20-year-old female. She initially presented with generalised tonic-clonic seizures preceded by nausea and headache on the fourth post-partum day along with a decreased Glasgow Coma Scale (8/15). Although clinical and laboratory examination including lumbar puncture, computerized tomography and magnetic resonance imaging were normal, a persistent headache was the only symptom. This headache improved dramatically after an epidural blood patch on the eighth post-partum day. The following discussion emphasises that various causes of post-partum seizures and headache should be considered before attributing it to dural puncture alone.

Postpartum seizures after epidural analgesia: a patient with a mutation of the factor V Leiden and prothrombin gene

We report the case of a 27-year-old parturient who developed a headache within 12 hours of delivery and who subsequently seized. Further examination, including magnetic resonance imaging and computed tomographic scan, showed a partial thrombosis of a transversal venous sinus, the underlying cause being an activated protein C resistance caused by a heterozygote factor V Leiden mutation and heterozygote prothrombin-gene mutation G20210A. Seven months after delivery, the patient is in good health, showing no neurocognitive disability.