CASE PRESENTATION
We report a case of a 31-year-old female who had a cesarean section
under spinal anesthesia with a history of gestational hypertension and
presented with severe positional headache, blurring of vision on the
5th postoperative day (POD) to a local hospital where
she had done her cesarean section. The headache was postural, mainly in
the front-occipital area, and worsened with upright posture.
Conservative management for headache was done in primary hospital but
couldn’t subside. So, she was referred to our hospital.
On the 7th POD, she was admitted to our hospital with
a worsening headache despite conservative and Non-steroidal
anti-inflammatory drug (NSAID) treatment. During the presentation, she
had difficulty speaking, and diplopia, and her Glasgow Coma Scale (GCS)
was E4V5M6.
On the 8th POD, the headache was persistent with
self-reporting NRS score of 7/10 even though she was on intravenous
fluids, NSAIDs, and opioids. A Sphenopalatine ganglion block was tried
but that helped only for a few minutes. The patient was planned for
epidural blood patch but refused to have the procedure because of her
bad prior experience with spinal anesthesia.
As an alternative to EBP, on the next day, intravenous neostigmine (20
mcg/kg) along with atropine (10 mcg/kg) was given over a period of 10
minutes. After 30 minutes of injection, her pain scoring (NRS) was 1/10,
and she did not require any forms of pain medication for 24 hours.