Differential Diagnosis for Post-Anesthesia Reaction with Unremitting Headache and Tremor

Single Most Likely Diagnosis

• Post-dural puncture headache (PDPH): This condition is a common complication of spinal or epidural anesthesia, characterized by a severe, unremitting headache that can be accompanied by tremors, nausea, and vomiting. The headache is typically worse when standing and improves when lying down.

Other Likely Diagnoses

• Migraine or tension headache exacerbated by anesthesia: Pre-existing migraine or tension headaches can be triggered or worsened by the stress of surgery and anesthesia, leading to severe, unremitting headaches.
• Postoperative vasospasm: Vasospasm of cerebral arteries can occur after surgery, leading to headaches and other neurological symptoms.
• Medication-induced headache: Certain medications used in anesthesia, such as nitrous oxide or volatile anesthetics, can cause headaches as a side effect.

Do Not Miss Diagnoses

• Subarachnoid hemorrhage (SAH): Although rare, SAH is a life-threatening condition that can present with a sudden, severe headache and can be mistaken for a post-dural puncture headache. Imaging with MRI or MRV is crucial to rule out SAH.
• Venous thrombosis: Cerebral venous thrombosis can cause headaches, tremors, and other neurological symptoms, and can be a complication of surgery or anesthesia.
• Intracranial hemorrhage: Any type of intracranial hemorrhage, including epidural or subdural hematoma, can present with severe headache and neurological symptoms.

Rare Diagnoses

• Cerebral vasculitis: Inflammation of the blood vessels in the brain can cause headaches, tremors, and other neurological symptoms, although this is a rare condition.
• Chiari malformation: A congenital condition where the cerebellum extends into the spinal canal, which can cause headaches and other neurological symptoms, especially after anesthesia.
• Pseudotumor cerebri: A condition characterized by increased intracranial pressure without a mass lesion, which can cause headaches, vision changes, and other symptoms.

In all cases, especially those that are Do Not Miss, imaging with MRI or MRV is essential to rule out life-threatening conditions and to guide further management.