Bilateral subdural hematoma secondary to accidental dural puncture

Abstract

We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

Cefalea post- punción dural

“…El hematoma subdural post-punción dural es una complicación rara pero extremadamente grave tras la punción dural (11). Esta se produce debido a la ruptura de las estructuras vasculares en el espacio subdural (10); al inicio el diagnóstico puede ser difícil, ya que tiene síntomas similares que CPPD, pero cuando la cefalea no responde a tratamiento médico estándar, pierde sus características posturales o se acompaña de otros trastornos neurológicos, es esencial sospechar de esta complicación.…”

Successful Treatment of Postdural Puncture Headache Using Epidural Fibrin Glue Patch after Persistent Failure of Epidural Blood Patches

“…Currently, there are very limited options available when PDPH remains refractory to epidural blood patch. Alternative therapies should be sought because puncture of the dura, if left untreated, can lead to permanent formation of CSF fistulae that can potentially result in fatal complications such as subdural hematoma and seizures . We describe the successful treatment of persistent PDPH with an epidural fibrin glue patch in a woman who had multiple failures of epidural blood patches.…”

“…2,3 The incidence of accidental dural puncture after neuraxial procedures varies from 0.4% to 6%, with a 60% rate of PDPH. 4 Risk factors of PDPH include large-bore cutting needle, young age, female, multiple needle punctures, previous history of PDPH, and low body mass index. 1,3 The size and type of needle are the most important factors that contribute to the incidence of PDPH.…”

“…Alternative therapies should be sought because puncture of the dura, if left untreated, can lead to permanent formation of CSF fistulae that can potentially result in fatal complications such as subdural hematoma and seizures. 1,4,5 We describe the successful treatment of persistent PDPH with an epidural fibrin glue patch in a woman who had multiple failures of epidural blood patches. Written consent was obtained from the patient to write and publish this case report.…”

“…It is postulated to be caused by either cerebral vasodilatation as a compensatory response to the excessive reduction in CSF volume and pressure, or caudal displacement of pain‐sensitive intracranial structures such as cranial nerves, falx cerebri, tentorium cerebelli, and cerebral vasculature . The incidence of accidental dural puncture after neuraxial procedures varies from 0.4% to 6%, with a 60% rate of PDPH . Risk factors of PDPH include large‐bore cutting needle, young age, female, multiple needle punctures, previous history of PDPH, and low body mass index .…”