Arnold Chiari Malformation Mimicking Postdural Puncture Headache in a Postpartum Female

Arnold Chiari malformations are a group of structural defects ranging from herniation of the hindbrain to skeletal deformities and neurological dysfunction. Type I Arnold Chiari is the most common type of malformation with a prevalence of 1 in 1000 births. Patients are frequently asymptomatic; however, if symptoms do develop, it is typically during the reproductive age. Suboccipital headaches and neck pain are the most common symptoms that one with type 1 Arnold Chiari will experience. Here we present a case of a 29 year old, Afican American female, G4P1021, who presented to our labor and delivery unit at forty weeks and two days of gestation complaining of regular painful uterine contractions. She delivered a healthy neonate vaginally with vacuum assistance and developed an occipital headache associated with neck pain on postpartum day 1. Her symptoms did not resolve after 2 blood patches at which point she was evaluated by neurology. Head imaging was performed and notable for an Arnold Chiari malformation.