Cerebellar infarction as a cause of post-partum headache.

A 32-year-old multiparous patient requested epidural analgesia during labour. The epidural was sited, apparently without complication, but the patient proceeded to an emergency caesarean section due to fetal distress, shortly after the insertion. The severity of the fetal distress meant that surgery was necessary before the epidural could be extended sufficiently and a general anaesthetic was administered. The next day the patient complained of a severe headache which she reported had started within ten minutes of epidural insertion. The headache persisted for many days. At no time were the features consistent with a post-dural puncture headache and she was investigated further by the neurologists. A magnetic resonance imaging (MRI) scan revealed an acute cerebellar infarct. The importance of correct diagnosis of post-partum headache and cerebellar infarction are discussed.