Caesarean Section with Spinal Anesthesia and Postspinal Headache

Purpose: To find out ‘what is the leading cause of postpartum headache in patients undergoing caesarean section with spinal anesthesia under elective conditions?’Methods: Our study was conducted with retrospective, controlled assessment of 304 patients who underwent caesarean section with spinal anesthesia under elective conditions at our institution between 1 June 2012 and 1 November 2012. The patients were assessed in terms of postpartum headache. They were divided into 2 groups: the group with headache versus the group without headache (the latter was the control group). Both groups were compared with respect to age, body mass index (BMI), number of previous pregnancies, indications for caesarean section, the spinal needle used during spinal anesthesia, preoperative and postoperative amount of fluid administration, and mobilization time.Results: None of the factors that are effective in development of headache, i.e. age, multiparity, the indication for caesarean section, BMI, and needle type, was statistically significant in logistic regression analysis. Only the needle type was significantly related to headache in Chi-Square test. All headache episodes were mild and improved with conservative therapy. We did not find any difference between groups with respect to age, BMI, number of previous pregnancies, indications for caesarean section, preoperative and postoperative amount of fluid administration, and mobilization time.Conclusion: In patients undergoing cesarean section with spinal anesthesia under elective conditions the main cause of headache is the type of the spinal needle used

Anterior sacral meningocele masquerading as an ovarian cyst: a rare clinical presentation associated with Marfan syndrome

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions