Patent Foramen Ovale and Paradoxical Embolism Complicating Postdural Puncture Headache in a Parturient.

BACKGROUND

Patent foramen ovale (PFO) is associated with migraine and cryptogenic ischemic stroke in young patients. Postdural puncture headache (PDPH) is the most likely cause of headache in a puerpera after epidural anesthesia.

CASE SUMMARY: A 34-year-old multipara presented with refractory postural headache, acute neurologic deficits, and elevated D-dimer following an accidental dural puncture during epidural analgesia for vaginal delivery. Investigations revealed right hemispheric infarction due to internal carotid artery occlusion, a latent PFO, and a history of migraine. Emergency thrombectomy led to full recovery.

DISCUSSION: This case suggests that PFO should be considered in postpartum women with intractable PDPH, and that strict bed rest may enhance thrombogenesis and predispose to paradoxical cerebral embolism, potentially worsening outcome.

TAKE-HOME MESSAGES: The association between PDPH, PFO-related headache, and stroke is rarely documented. In puerperae with intractable PDPH refractory to standard therapy, consider PFO.