Mark Mamlouk: The Hidden CSF Leak in Postpartum Headache
Mark Mamlouk, Neuroradiology Lead, Director of Spinal CSF Leak Program at The Permanente Medical Group, shared a post on LinkedIn about a recent article he and his colleague co-authored, published in AJNR, adding:
“Excited to share our new paper in American Journal of Neuroradiology, which describes four postpartum patients with cerebral venous thrombosis (CVT) and coexisting spinal CSF leakage after inadvertent dural puncture.
In all four patients, the CVT was identified – but the concurrent MRI findings of intracranial hypotension were initially overlooked.
This is an important diagnostic intersection for obstetricians, anesthesiologists, neurologists, emergency physicians, and radiologists.
A diagnosis of CVT should not necessarily end the evaluation of a postpartum headache, particularly following epidural anesthesia.
Three practical takeaways:
- In a postpartum patient with CVT, consider whether a spinal CSF leak may also be present.
- If a presumed post-dural puncture headache worsens, loses its postural character, or develops associated neurologic signs, exclude CVT.
- When both are present, both may require treatment: anticoagulation for the CVT and, when appropriate, an epidural blood patch for the CSF leak.
Grateful to my coauthor Dr. Ajay Madhavan for collaborating on this work.”
Title: Postpartum Cerebral Venous Thrombosis and Spinal CSF Leak after Epidural Anesthesia
Author: Mark D. Mamlouk, Ajay A. Madhavan
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