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Correspondence to Author: Shazia Khan, MS (Obs & Gyn) FMIGS ^a ; Aparna Krishnamurthy, DNB (Obs & Gyn) ^a ; Arindam Mukherjee, MD (Medicine) DM Neurology ^b; Sachin Girdhar, MD(Radiodiagnosis), DM Interventional Radiology ^c ; Roobina Grewal, MBBS ^a . 

a:From the Department of Obstetrics and Gynecology, INHS Asvini ,Colaba, Mumbai, India.
b:From the Department of Medicine, INHS Asvini, Colaba, Mumbai, India.
c:From the Department of Radiodiagnosis, INHS Asvini, Colaba, Mumbai, India.

DOI: 10.52338/jocogr.2026.5771

Abstract:

Headache following caesarean delivery under spinal anaesthesia is a common postoperative complaint and is most frequently attributed to postdural puncture headache (PDPH). However, clinicians must remain vigilant for secondary neurological causes — particularly when symptoms evolve atypically or fail to respond to conservative measures. These include postpartum eclampsia, Reversible Cerebral Vasoconstriction Syndrome (RCVS), and Posterior Reversible Encephalopathy Syndrome (PRES). We present a case of a 30-year-old multiparous woman who developed persistent headache following an elective lower segment caesarean section (LSCS) under spinal anaesthesia. Initially managed as PDPH, her clinical course was complicated by progressive bradycardia, acute-onset hypertension, visual disturbances, and ultimately a generalized tonic-clonic seizure. Brain MRI confirmed RCVS–PRES spectrum disorder with characteristic patchy T2/FLAIR hyperintensities in bilateral parieto-occipital regions, posterior cingulate gyrus, and bilateral lentiform nuclei. The final diagnosis was postpartum eclampsia concurrent with RCVS–PRES spectrum disorder. Multidisciplinary management with magnesium sulphate, intravenous labetalol, levetiracetam, and nimodipine resulted in complete neurological recovery and safe discharge. This case underscores the critical importance of maintaining a high index of suspicion for overlapping neurological entities in any postpartum patient with refractory headache.

Keywords: RCVS, PRES, postpartum eclampsia, post-dural puncture headache, spinal anaesthesia, LSCS, postpartum headache, cerebral vasoconstriction..

Citation:

Dr. Shazia Khan, MS (Obs & Gyn) FMIGS, Postpartum Diagnostic Trap: RCVS–PRES Spectrum Disorder Masquerading As Post-Dural Puncture Headache Following Elective LSCS. Journal of Clinical Obstetrics and Gynecology Research 2026.