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

A 27-year-old parturient developed a severe headache after placement of 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 mal 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 of this drug in parturients.