Remote spinal epidural haematoma after spinal anaesthesia presenting with a ‘spinal lucid interval’

Madhugiri, Venkatesh S; Singh, Manish Kumar; Sasidharan, Gopalakrishnan M; Kumar, Vimal

doi:10.1136/bcr-2012-007258

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…2 Regarding neuraxial techniques, the level of the hematoma is usually the level of puncture or up to the highest level of catheter insertion. 3 Hemorrhagic complications, far from needle puncture site, attributed to anesthesia, have been reported mainly as cerebral subdural hematomas, where the possible mechanism is the caudal shift of intracranial structures due to low CSF pressure causing traction on dural veins with subsequent bleeding. 3,4 The etiological relation to bemiparin cannot be excluded, as onset of symptoms corresponds to the timing of its maximal plasma antiXa activity (2-6 h).…”

Section: Discussionmentioning

confidence: 99%

“…3 Hemorrhagic complications, far from needle puncture site, attributed to anesthesia, have been reported mainly as cerebral subdural hematomas, where the possible mechanism is the caudal shift of intracranial structures due to low CSF pressure causing traction on dural veins with subsequent bleeding. 3,4 The etiological relation to bemiparin cannot be excluded, as onset of symptoms corresponds to the timing of its maximal plasma antiXa activity (2-6 h). The interval between initiation of low molecular weight heparin and onset of neurological dysfunction due to hematoma ranges between 15 h and 3 days, which is in agreement with our finding.…”

Section: Discussionmentioning

confidence: 99%

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Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site

et al. 2014

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Study design: Case report. Objectives: We report a case of spinal epidural hematoma (SEH) that appeared on the third postoperative day after lumbar spinal anesthesia, far from the needle puncture site. Possible mechanisms and etiological relation to patient's risk factors as well as diagnosis and management of SEH are briefly discussed. Setting: Asklepieion General Hospital of Voula, Athens, Greece. Methods and results: A 64-year-old woman underwent an uneventful total knee arthroplasty operation under a spinal anesthetic. A lumbar puncture was performed in the L2-L3 interspace, that was atraumatic and successful on the first attempt. The operation was uneventful. On the third postoperative day, the patient developed a SEH that expanded from C2 to T3 levels. She was presented with bilateral shoulder pain, muscle weakness of the upper extremities with normal sensation, followed by paraparesis. The magnetic resonance imaging (MRI) revealed a large vascular malformation, partially ruptured forming a hematoma compressing the spinal cord toward the vertebral bodies The patient was treated conservatively and full recovery was achieved. Conclusion: The possibility of SEH must be considered whenever neurological symptoms occur in the postoperative period, especially after a neuraxial blockade. The causes are multiple, a not-known lesion predisposing to bleeding and hematoma formation may preexist and the anesthetic technique can be directly or indirectly connected to this complication. MRI is the preferred diagnostic method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site

et al. 2014

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Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Lagerkranser

2017

Scandinavian Journal of Pain

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AbstractBackgroundBleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs such as meningitis, abscess, cardiovascular collapse, and nerve injury, neurological injury associated with SH has the worst prognosis for permanent harm. Around the turn of the millennium, the first guidelines were published that aimed to reduce the risk of this complication. These guidelines are based on known risk factors for SH, rather than evidence from randomised, controlled trials (RCTs). RCTs, and therefore meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing published case reports of rare complications may at least reveal risk factors and can thereby improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015, and compare these with previous reviews of case reports.MethodsMEDLINE and EMBASE were used for identifying case reports published in English, German, or Scandinavian languages, using appropriate search terms. Reference lists were also scrutinised for case reports. Twenty different variables from each case were specifically searched for and filled out on an Excel spreadsheet, and incidences were calculated using the number of informative reports as denominator for each variable.ResultsAltogether 166 case reports on spinal haematoma after CNB published during the years between 1994 and 2015 were collected. The annual number of case reports published during this period almost trebled compared with the two preceding decades. This trend continued even after the first guidelines on safe practice of CNBs appeared around year 2000, although more cases complied with such guidelines during the second half of the observation period (2005–2015) than during the first half. Three types of risk factors dominated:(1)Patient-related risk factors such as haemostatic and spinal disorders, (2) CNB-procedure-related risks such as complicated block, (3) Drug-related risks, i.e. medication with antihaemostatic drugs. Conclusions and implicationsThe annual number of published cases of spinal haematoma after central neuraxial blocks increased during the last two decades (1994–2015) compared to previous decades. Case reports on elderly women account for this increase.Antihaemostatic drugs, heparins in particular, are still major risk factors for developing post-CNB spinal bleedings. Other risk factors are haemostatic and spinal disorders and complicated blocks, especially “bloody taps”, whereas multiple attempts do not seem to increase the risk of bleeding. In a large number of cases, no risk factor was reported. Guidelines issued around the turn of the century do not seem to have affected the number of published reports. In most cases, guidelines were followed, especially during the second half of the study period. Thus, although guidelines reduce the risk of a post-CNB spinal haematoma, and should be strictly adhered to in every single case, they are no guarantee against such bleedings to occur.

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Remote spinal epidural hematoma after spinal anesthesia for caesarean section

Vilaça

Faísco

Reis

et al. 2017

Journal of the Portuguese Society of Anesthesiology

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Remote spinal epidural haematoma after spinal anaesthesia presenting with a ‘spinal lucid interval’

Cited by 4 publications

References 15 publications

Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site

Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site

Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Remote spinal epidural hematoma after spinal anesthesia for caesarean section

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