Patent Foramen Ovale and Paradoxical Embolism Complicating Postdural Puncture Headache in a Parturient.

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-20 DOI:10.1016/j.jaccas.2026.110769

Jiale Liu, Chang Liu, Xiang Zheng, Shenghua Li, JuanJuan Huang, Xiaonan Du, Jingli Chen

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Abstract

Background: Patent foramen ovale (PFO) is associated with migraine and cryptogenic ischemic stroke in young patients. Postdural puncture headache (PDPH) is the most likely cause of headache in a puerpera after epidural anesthesia.

Case summary: A 34-year-old multipara presented with refractory postural headache, acute neurologic deficits, and elevated D-dimer following an accidental dural puncture during epidural analgesia for vaginal delivery. Investigations revealed right hemispheric infarction due to internal carotid artery occlusion, a latent PFO, and a history of migraine. Emergency thrombectomy led to full recovery.

Discussion: This case suggests that PFO should be considered in postpartum women with intractable PDPH, and that strict bed rest may enhance thrombogenesis and predispose to paradoxical cerebral embolism, potentially worsening outcome.

Take-home messages: The association between PDPH, PFO-related headache, and stroke is rarely documented. In puerperae with intractable PDPH refractory to standard therapy, consider PFO.

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卵圆孔未闭和矛盾栓塞并发硬脊膜后穿刺头痛1例。

背景：在年轻患者中，卵圆孔未闭（PFO）与偏头痛和隐源性缺血性中风有关。硬脊膜穿刺后头痛（PDPH）是产妇在硬脊膜外麻醉后最常见的头痛原因。病例总结：一名34岁的多子产妇在阴道分娩硬膜外镇痛时意外硬膜穿刺后出现难治性体位性头痛、急性神经功能障碍和d -二聚体升高。调查显示右半脑梗死由于颈内动脉闭塞，一个潜在的PFO，和偏头痛的历史。急诊取栓使患者完全康复。讨论：本病例提示产后难治性PDPH妇女应考虑PFO，严格的卧床休息可能会促进血栓形成，易发生矛盾性脑栓塞，潜在地恶化预后。关键信息：PDPH、pfo相关头痛和中风之间的联系很少有文献记载。对于标准治疗无效的难治性PDPH产妇，可考虑PFO。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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