Differential Diagnosis for Severe Headache after Complete Miscarriage with Sepsis Criteria
Single Most Likely Diagnosis
- Post-dural puncture headache (PDPH): This condition can occur if the patient underwent a procedure requiring epidural or spinal anesthesia during the management of her miscarriage, and there was an accidental dural puncture. The headache is typically severe, worsens in the upright position, and improves with lying down.
Other Likely Diagnoses
- Meningitis: Given the context of sepsis, meningitis is a plausible diagnosis. It could be due to bacterial, viral, or fungal causes, especially if the patient's immune system is compromised or if there was a breach in the meninges during a medical procedure.
- Cerebral venous sinus thrombosis: This condition can be associated with pregnancy, the postpartum period, and conditions leading to hypercoagulability. It presents with headache, which can be severe and is often accompanied by other neurological symptoms.
- Preeclampsia or eclampsia: Although less common after a miscarriage, if the patient had undiagnosed preeclampsia that led to the miscarriage, she could still be at risk for eclampsia, characterized by new-onset seizures in a patient with preeclampsia.
Do Not Miss Diagnoses
- Subarachnoid hemorrhage: This is a life-threatening condition that requires immediate diagnosis and treatment. It could be related to the physical stress of miscarriage, especially if there were complications, or to an underlying vascular malformation.
- Encephalitis: Similar to meningitis, encephalitis is an infection of the brain tissue itself and can present with severe headache, fever, confusion, and altered mental status.
- Cortical vein thrombosis: Part of the spectrum of cerebral venous thrombosis, this condition can present with headache and focal neurological deficits.
Rare Diagnoses
- Pituitary apoplexy: A rare condition where there is sudden hemorrhage or infarction of the pituitary gland, often presenting with severe headache, visual disturbances, and acute endocrine deficiencies.
- Reversible cerebral vasoconstriction syndrome (RCVS): Characterized by sudden, severe headaches (often described as "thunderclap") and reversible vasoconstriction of cerebral arteries, which can be precipitated by various factors including pregnancy and the postpartum period.
- Intracranial hemorrhage: Although more commonly associated with hypertension or vascular malformations, it could occur in the context of sepsis or coagulopathy, presenting with sudden, severe headache.