Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura

Abstract

Background and objectives:Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other 33 cases found on literature review.

A Case Report of a Subdural Hematoma following Spinal Epidural prior to a Total Knee Arthroplasty

“…Subdural hematoma can also be a complication of spinal surgery and patients presented with symptoms anywhere between 6 hours and 50 days postoperatively and 62% of cases with cerebrospinal leaks came from the lumbar spine [ 22 ]. There are also reported cases of cervical cerebrospinal leakage causing recurrent subdural hematoma, and this possibility should be taken into consideration when a patient presents with recurrent chronic or bilateral chronic SDH [ 23 ].…”

Pituitary Apoplexy and Subdural Hematoma after Caesarean Section

“…Conservative nonsurgical management for subdural hematoma may be considered if the accumulation does not cause impingement on the brain or brain stem. Surgical evacuation should be performed promptly if there are signs of increased intracranial pressure threatening vital functions [ 21 , 22 ]. Hypopituitarism can resolve on its own in some cases; in others, it will lead to irreversible hormone deficiencies.…”

Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso

“…The literature also shows that there are many factors enhancing this mechanism and contributing to the pathogenesis of subdural hematoma after a puncture of subarachnoid space. Those factors include excessive CSF loss due to use of thick needles or with sharp edges to perform spinal anesthesia, as well as multiple attempts or due to inadvertent dural puncture during epidural anesthesia 13,14 ; patients with pre-existing neurologic diseases 15 , like the presence of brain aneurysms or arteriovenous malformations, cortical atrophy; alcohool consumption, use in pre or postoperative periods of anticoagulant medications, dehydration and pregnancy. However, using fine needles and/ or with blunt tip (Whitacre) does not eliminate the possibility of occurrence of this complication, as reported here and in other literature cases 16,17 .…”

“…In many cases presented in the literature, initial diagnosis was masked by a single diagnosis of headache after spinal anesthesia 13,14,[18][19][20][21] . According to a review of literature of 21 subdural hematoma cases after inadvertent dura mater puncture, the earliest diagnosis occurred two days after the epidural anesthesia and the latest occurred after 20 weeks 21 .…”