A 25-year-old woman presented with increasingly severe headache and two generalised seizures, 36 hours after the normal vaginal delivery of her first baby at 40 weeks’ gestation. She had been treated with epidural analgesia during labour.
On examination, her temperature was 37.6°C, she was drowsy, there was a mild left hemiparesis and both plantar responses were extensor.
What is the most likely diagnosis?
A: bacterial meningitis
B: pre-eclamptic toxaemia
C: subarachnoid haemorrhage
D: venous sinus thrombosis
E: viral encephalitis
Correct answer: D Explanation The combination of headache, increasing drowsiness (suggesting rising intracranial pressure), focal neurological signs and seizures in a woman shortly post partum is highly suggestive of a venous sinus thrombosis.