• M del-Rio-Vellosillo, J J Garcia-Medina, L E Fernandez-Rodriguez, R Martin-Gil-Parra, J Lopez-Perez, and M J Almagro-Navarro.
• Department of Anesthesia, University Hospital Virgen de la Arrixaca, Murcia, Spain.
• Acta Anaesthesiol Scand. 2014 Aug 1;58(7):897-902.

BackgroundAnaesthetists need to know the different causes of persistent headache or a change in level of consciousness following epidural analgesia for labour. Failure to recognise these neurological complications can lead to delayed diagnoses, with subsequent serious implications.MethodsWe present a patient who was re-admitted for postural headache resulting from an unrecognised dural puncture during an epidural for pain relief while in labour. During the interview, the patient confirmed drug use (cocaine), so she was evaluated by a psychiatrist with possible post-partum psychosis or drug withdrawal syndrome. Afterwards, the patient deteriorated neurologically, showing impaired consciousness and seizures.ResultsThe cranial computed tomography showed bilateral frontoparietal subdural collections with intraparenchymal and subarachnoid haemorrhaging. She improved by burr hole drainage of subdural hygroma and a blood patch.ConclusionsNeurological signs should alert the clinician to the possibility of subdural collection and other possible complications such as sinking of the brain in order not to delay the request for imaging tests for diagnoses and effective treatments.© 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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