Improved acuteand rehabilitative careand emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers
We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal Epidural anaesthesia was attempted but, despite a negative test dose, injection of local anaesthetic resulted in a generalizedSpinal haematoma, occurring either spontaneously or after regional block can result in severe, permanent neurological deficit. However, this complication is exceedingly rare. There are no case reports of spinal haematoma associated with epidural anaesthesia in a parturient without antecedent lumbar pathology. ~ This report describes the occurrence of a spinal subdural haematoma after attempted epidural anaesthesia in a parturient with severe preeclampsia.
Case reportA 36-yr-old, 60 kg, gravida 3, para 2 woman presented at 30.5 wk gestation with severe preeclampsia. Her medical history before pregnancy was unremarkable except for an unspecified psychiatric illness for which she was treated with trifluoperazine. There was no history of a bleeding disorder. Examination of the medical records from the transferring hospital revealed that the patient had complained of severe back pain radiating down both legs which was not associated with any neurological deficit. This lasted about six hours and had resolved before she was transferred to our hospital for management of severe preeclampsia. Upon arrival, her blood pressure was 160/100 mmHg and four plus proteinuria was found on dipstick examination. Serum electrolytes, uric acid and CAN J ANAESTH 1993 / 40:4 / pp M0-5Lao el al.: SPINAL HAEMATOMA 341 liver enzymes were normal except for elevated alkaline phosphatase of 880 IU (normal range, 38-110). Her haemoglobin concentration was 121 g. L -I. She had a normal prothrombin time (PT, 10.5 see), bleeding time (three minutes), and fibrinogen (7.66 g-L-l). The fibrin split products were marginally elevated (20 mg-L -1, normal = < 10). The platelet count was 425,000. mm -3, activated partial thromboplastin time (aPTT) was prolonged to 49 sec (n = 24-36). The patient's blood pressure remained elevated in spite of continued treatment with magnesium sulphate and parenteral hydralazine. Ten hours later she had a small vaginal bleed, which suggested the diagnosis of placental abruption. She was prepared for an urgent Caesarean section under epidural anaesthesia. On arrival in the operating room her blood pressure was 150/100 mmHg. While monitoring the patient with a pulse oximeter, ECG, and automatic blood pressure cuff, a 20-gauge epidural catheter was placed atraumatically through a 17-ga Tuohy needle at the I..2-L 3 interspace. Following a negative aspiration test, a three ml test dose of lidocaine hydrocarbonate 2% with five 0-g" ml -~ epinephrine was given without change in blood pressure or heart rate. A further 5 ml of the same solution was t...
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