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Introduction
Migraines are a common post-surgical and puerperal complaint, consistent with a myriad of etiologies, encompassing physiological changes, hormonal modifications, peri-surgical procedures and unknown prenatal conditions. The primary causes include tension-type headaches, cluster headaches and other trigeminal nerve cephalgia (1,2). Secondary headaches are are less common but can have severe consequences with significant mortality and morbidity if they are overlooked. Diagnosis of a secondary cause is a daunting task, taking into account that headache can be the only symptom of multiple conditions such as postdural puncture headache (PDPH), pneumocephalus, preeclampsia and eclampsia, meningitis, cerebral venous thrombosis, ischemic or hemorrhagic stroke, subarachnoid haemorrhage, reversible cerebral vasoconstriction syndromes, posterior reversible leukoencephalopathy syndrome and pituitary adenoma. Therefore, a high index of suspicion is required, and a low threshold for a neuroimaging investigation when dealing with postpartum headaches is needed (3,4). Needless to say, any suspicion of a secondary headache should be investigated by a multidisciplinary team due to the challenges posed by such wide-ranging conditions. Although pituitary adenoma is seldom a differential diagnosis in pregnancy and postpartum headache, it is part of a differential diagnosis when associated with visual loss. Ocular visual impairment is the next common symptom in pituitary adenoma after headache. We present the case of postpartum pituitary apoplexy, following an emergency Caesarean section.
Case report
After obtaining approval of the Ethics Committee of the National Institute of Mother and Child Care (Bucharest, Romania) (no. 25/2019), data of the patient were reviewed and presented in the current case report. A 26-year-old primigravida, 40 weeks gestation, was admitted to our maternity ward at the National Institute of Mother and Child Care, in spontaneous labour. She delivered a 3,150 g female baby, Apgar score 9, through Category II Caesarean section for failure to progress. The anaesthetist performed spinal anaesthesia with bupivacaine and fentanyl. Caesarean section was routine and pain-free, with an estimated blood loss of approximately 400 ml. Pre-delivery haemoglobin was 11.5 g/dl and at post-delivery the value was slightly decreased at 10.2 g/dl. She had no prior medical history, and her antenatal care was uneventful. The immediate postpartum period was unremarkable. The patient remained alert and orientated with normal vital signs. The following day she was transferred to the postnatal ward. Approximatively 48 h post-delivery she presented...