A 28-year-old woman develops a severe bifrontal headache three days after spinal anaesthesia for caesarean delivery. The headache is worse on standing and relieved completely when supine, with mild photophobia but no focal signs. Conservative measures including hydration, analgesia and caffeine fail over 48 hours. The MOST appropriate next step is:

• A Epidural blood patch ✓
• B Lumbar puncture for CSF examination
• C Sumatriptan infusion
• D CT venography followed by anticoagulation

Explanation

The orthostatic pattern after dural puncture confirms postdural puncture headache. Initial management is supportive with analgesia, fluids, bed rest and caffeine, but an autologous epidural blood patch at the level of the dural puncture gives relief in 70 to 90 percent of patients and is indicated when severe symptoms persist beyond about 48 hours despite conservative care. Repeating lumbar puncture risks enlarging the leak, and imaging plus anticoagulation address cerebral venous thrombosis, which presents with progressive headache and neurological signs.

Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.