A case report of intracranial hemorrhage after spinal anesthesia

Abstract

BackgroundChronic subdural hematoma (CSDH) after spinal anesthesia is a rare complication. We experienced a patient who developed CSDH after postdural puncture headache (PDPH) following combined spinal and epidural anesthesia (CSE).Case presentationA 38-week-gestation parturient with a history of previous cesarean delivery underwent elective cesarean section under CSE. She had been receiving aspirin therapy for Kawasaki disease for many years. She developed a symptom of PDPH 1 day after the surgery. Fluid administration and analgesics were started. Although the headache was relatively severe and persistent, it suddenly disappeared on the third postoperative day. Aspirin administration was restarted on the third postoperative day, and the patient was discharged 1 week after the surgery. 2 weeks after being discharged, she was readmitted to our hospital for severe headache and was diagnosed as having CSDH. An epidural blood patch was performed, resulting in resolution of the hematoma.ConclusionsWe experienced a case of CSDH after PDPH in a patient who was receiving aspirin therapy. Aspirin therapy should be restarted after confirmation of the absence of headache. We should consider the possibility of unexpected disappearance of PDPH in the postoperative period may be due to the development of CSDH.

Post‐Dural Puncture Headache Evolving to a Subdural Hematoma: A Case Report

“…In other cases, the first symptoms matched PDPH and were treated accordingly. The headache disappeared but returned in 3 days to several weeks after the puncture, 9,11 just like in the earlier reported cervical case 5 . In one case, the only symptom was diplopia, which started 10 days after the spinal anesthesia.…”

“…Several case reports of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have already been published 7–11 . The symptoms ranged from diplopia, 7 severe (nonpostural) headache, 9 or headache and vomiting, 11 to hemiparesis 10 or loss of consciousness 8 . Several patients presented with subdural hematoma within 48 hours 8,10,11 .…”

“…In one case, the only symptom was diplopia, which started 10 days after the spinal anesthesia. In all the cited cases, invasive therapy was performed, ranging from a blood patch 9 to burr holes 11 and even craniectomy 7,8,10 . In one case the use of aspirin might have been an aggravating factor 9 …”

“…As already mentioned, several different treatment options have been described: observation, blood patch, burr hole drainage, craniectomy, or a combination 5–16 . The choice should be based on the patients’ neurological status and the size of the hematoma.…”

Post-Lumbar Puncture Chronic Intracranial Subdural Hematoma

“…Hematomas less than five millimeters often spontaneously subside. [9] A prompt epidural blood patching may restrict the risk of subdural bleeding by preventing a fall in cerebrospinal fluid pressure and has resulted in an equivocal outcome in certain cases. 10 Acute subdural hematomas are deftly identified by a cranial computerized tomogram scan, whereas chronic intracranial lesions may need magnetic resonance imaging or cerebral angiography.…”