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.