Pearls and Oy-sters: Post-dural Puncture Headache, Cerebral Sinus Venous Thrombosis, and Reversible Cerebral Vasoconstriction Syndrome in the Peripartum.

We report the case of a 34-year-old female patient complaining of headaches one day after childbirth, initially interpreted as post-dural puncture headache (PDPH) and treated successfully with an epidural blood patch. Five days later, she presented an acute proportional right sensorimotor hemisyndrome and a new onset left-sided headache, attributed to a venous stroke from left-sided cerebral sinus venous thrombosis (CSVT). Simultaneously, we found radiological signs of reversible cerebral vasoconstriction syndrome (RCVS), considered as asymptomatic. We started the patient on anticoagulant therapy and she showed full motor recovery at the 3-month clinical follow-up.PDPH, CSVT and RCVS are well-known neurological complications of the peripartum period. All three conditions present with headaches and headache features may overlap, masking co-occurrence and making accurate diagnosis (differentiation) of these diseases difficult. Each disease can potentially lead to disabling deficits, but all respond to specific treatment.Knowledge of the causes of headaches in the peripartum period, their specific clinical characteristics and potential complications helps to prioritize and interpret diagnostic tests to offer appropriate therapy.