{
  "abstract": "Background and Aims Post-dural puncture headache (PDPH) is a common complication of neuraxial techniques. Despite rare, progression to cerebral venous thrombosis (CVT) may occur. Risk factors such as thrombophilia and hypercoagulability increase vulnerability. We present a case of PDPH complicated by CVT in a high-risk obstetric patient.Methods 32-year-old primigravida at term, ASA III, with class III obesity, prior pulmonary embolism, and heterozygosity for the prothrombin G20210A mutation requiring labor analgesia. Combined spinal-epidural was performed with a 27G Whitacre needle at L3-L4, followed by successful epidural catheter placement. The patient developed a positional occipital headache radiating to the posterior neck, consistent with PDPH. Conservative management achieved transient clinical improvement. Nine days later, she returned to the emergency department with persistent non-positional headache. Diagnostic imaging revealed CVT of the superior sagittal and lateral sinuses. Neurology consultation confirmed the diagnosis, supported by elevated D-dimers, venous CT, and brain MRI findings. An epidural blood patch and therapeutic anticoagulation with enoxaparin were instituted.Results Gradual clinical improvement and favorable radiological evolution were observed during follow-up.Conclusions Persistent or atypical headaches after neuraxial anesthesia should instigate prompt re-evaluation and neuroimaging. Recognizing predisposing factors and maintaining a high index of suspicion improve early diagnosis of potential complications. Vigilance, early recognition, and treatment are essential to optimize outcomes and prevent serious morbidity.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Tânia Barros"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Luís Gonçalves"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Raquel Fonseca"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Décia Gonçalves"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Lúcia Gonçalves"
    },
    {
      "affiliations": [
        "Anaesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal"
      ],
      "name": "Elisabete Valente"
    }
  ],
  "title": "P014 Persistent post-dural puncture headache unmasking cerebral venous thrombosis: a rare complication",
  "uid": "2944a97f-048f-5913-a0ac-784025b34df5"
}