Headache is common in the postpartum period. Post-dural puncture headache (PDPH) is the most common major complication after spinal anaesthesia. The clinical features and history of spinal anaesthesia are sufficient for diagnosis. However, the differential diagnosis is extensive and the evaluation of persistent symptoms requires a multidisciplinary approach for diagnosis and treatment. Here, we report an 31 year-old woman with a history of normal pregnancy, presenting with persistent headache that started on postpartum day 2, and was refractory to conservative therapy of PDPH; the patient developed hypertension, seizures, visual disturbances, and altered mental status on postpartum day 7. The clinical outcome and neuroimaging findings of the patient were compatible with an atypical presentation of posterior reversible encephalopathy syndrome (PRES) associated with late postpartum preeclampsia. She showed dramatic improvement with antihypertensive therapy. PRES is a frequently reversible acute neurologic entity with different aetiologies including preeclampsia/eclampsia. However, a delay in diagnosis and treatment can result in permanent brain damage and death. Therefore, it is important to recognise atypical clinical and radiological presentations of PRES for early diagnosis and treatment.
Keywords: Postpartum, post-dural puncture headache, PRES, preeclampsia, magnetic resonance imaging