Postpartum bilateral subdural hematomas following spinal anesthesia: Case report

Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome

“…18 Predisposing conditions leading to excessive CSF leakage may include expulsive efforts (Valsalva maneuver) during labour 3 and cerebral atrophy. 4 Several other factors may increase the risk of intracranial bleeding: severe hypertension and thrombocytopenia as was the case in our patient. In addition, the patient may have had platelet dysfuction associated with preeclampsia and HELLP syndrome.…”

“…24 Treatment may be surgical or conservative. 4,13 Our patient did not require surgery because of the small size of the subdural hematomas and improvement of the neurological signs. Conservative treatment is in agreement with two previously published studies.…”

“…Cerebrospinal fluid leakage from the punctured dura may reduce the intracranial pressure leading to stretch and tearing of subdural veins 2 even in healthy individuals. Contributory factors in the development of this pathology could be Valsalva maneuver, 3 brain atrophy 4 or thrombocytopenia together with possible platelet dysfunction as occurs in severe preeclamptic parturients. 5 The present case report emphasizes the need for careful assessment and consideration of the influence of platelet pathology as a predisposing factor.…”

Hematoma subdural após punção inadvertida da dura-máter: relato de caso

“…Não foram observados outros sinais e sintomas que poderiam acompanhar o hematoma subdural, como náuseas, vômitos, borramento visual, desorientação 7,13 ; notando-se apenas cefaléia e diplopia, comum nos casos de CPPD 14 . O tratamento do hematoma subdural pode ser cirúrgico ou conservador 15,16 . Nesse caso, não foi necessária intervenção cirúrgica, apenas conduta clínica, devido ao pequeno tamanho do hematoma, da melhora gradual dos sintomas neurológicos e da regressão do hematoma subdural nos controles por métodos de imagem subseqüentes.…”

Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco‐abdominal aneurysm

“…Brachial plexus blocks above the clavicle have been associated with respiratory failure in sick patients [7]. Although axillary brachial plexus block has not been associated with impaired lung function, it is not usually recommended for surgery around the elbow, being`best suited for surgery of the forearm and hand' [8]. Blockade of the brachial plexus at the axillary level may result in inadequate anaesthesia of the terminal nerves that arise from the brachial plexus cords and provide innervation to the upper arm.…”