A 37-year-old patient, whose only recorded medical history was asthma.
She had received epidural analgesia 1 month before for a normal delivery in another hospital.
The hospital discharge report indicated accidental dural puncture during the epidural technique and occipital headache during the first 12 h postpartum, which had stopped with medical treatment (caffeine, paracetamol) and rest.
However, once at home, the patient began again with occipital pain that was treated daily with analgesics; after 1 month of recurrent pain, she consulted the emergency department of our hospital.
The patient had occipital pain that worsened with standing and Valsalva maneuvers.
Afebril.
Magnetic resonance imaging (MRI) of the brain revealed type I Chiari malformation (causal displacement of cerebellar tonsils through the orifice) and diffuse thickening.
The patient was referred to the anesthesia service for performing an epidural patch but refused the technique due to fear of a new epidural.
Treatment with dexamethasone and analgesics was started and pain subsided after 4 days.
1.
At 6 months, the patient was reviewed in neurology outpatient clinics, and a new MRI was performed, showing the persistence of the anatomical abnormality corresponding to Chiari I ́s syndrome, but it was found that there was meningeal thickening.
Clinically, the patient did not complain of pain at baseline, but indicated that she had pain in relation to Valsalva maneuvers or cough; according to her, this symptom was prior to this process.
