Elsevier

Journal of Clinical Anesthesia

Volume 4, Issue 1, January–February 1992, Pages 48-51
Journal of Clinical Anesthesia

Case report
Grand mal seizure in a postpartum patient following intravenous infusion of caffeine sodium benzoate to treat persistent headache

https://doi.org/10.1016/0952-8180(92)90121-GGet rights and content

Abstract

A 27-year-old parturient developed a severe headache after placement o f a labor epidural catheter. A presumptive diagnosis of an occult postdural puncture headache (PDPH) was made, and the patient was treated with an intravenous (IV) infusion of 500 mg of caffeine sodium benzoate (CSB) to vasoconstrict dilated cerebral vessels. Shortly after the infusion was completed, the patient experienced a self-limited grand mat seizure, which recurred later during her hospitalization. Despite a neurologic consultation and extensive testing, no definitive cause for the seizure was found. In light of the temporal relationship between caffeine use and the development of seizure activity, reports implicating caffeine's contribution to seizure activity, and evidence of a prolongation of the substance's half-life during and after pregnancy, we urge caution in the use o f this drug in parturients.

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    In a case report, a patient with newly diagnosed epilepsy reported drastic amelioration of seizure frequency when he stopped drinking 2L of ice tea per day [22]. Inaugural seizures have also been reported in young women without epilepsy receiving oral or intravenous caffeine for post-lumbar puncture syndrome [23–25]. Based on available data, some authors have advised against coffee consumption in patients with epilepsy.

  • Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch

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    Given the small number of cases it is difficult to support this recommendation.101 Postnatal seizures may result from hypertensive disease, epilepsy, haemorrhage, thrombosis, infection and space occupying lesions, but have also been reported after dural puncture in association with PDPH;102 and after some modes of treatment, notably caffeine,58,103–105 Synacthen,106 sumatriptan106 and EBPs.59 The nature of these relationships is uncertain. No studies have examined if an EBP reduces the incidence of seizures in those with PDPH.

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Assistant Professor of Anesthesiology, University of Illinois-Chicago College of Medicine

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