Spinal subdural haematoma as a complication of immediate epidural blood patch

Abstract

In 1960, Gormley described the technique of injecting autologous unclotted blood into the epidural space near a dural puncture hole for the treatment of post-dural puncture headaches, the so called "epidural blood patch" (EBP). l The literature since then suggests that the tech-CAN J ANAESTH 1996 I 43:3 / pp306-9

Epidural injection with saline for treatment of postspinal headache: comparison with epidural blood patch

“…It has been reported that neurological complications, such as paresthesia, back pain [6], spinal subdural hematoma [8], and others [9], are likely to occur during and immediately after the EBP procedure. In a recent study utilizing MRI technology, Beards et al [17] demonstrated in symptomatic patients that EBP caused a compression over the dural sac and the nerve roots, by which some neurologic complications occurring after the EBP procedure may be caused.…”

“…Epidural blood patch (EBP) has been reported to be an effective treatment in about 60%-90% of postdural puncture headaches [2][3][4]. Although EBP is a recognized treatment for PSH [5][6][7], this treatment has been associated with complications such as paresthesia, back pain [3], spinal subdural hematoma [8], and others [9]. In addition, we successfully treated a Jehovah's Witness with postspinal headache with a bolus of saline followed by continuous infusion into the epidural space.…”

Is Epidural Blood Patch Innocent? Case Discussion

“…tarafından tanımlanan altı EKY uygulaması sonrasında, spinal subdural hematomla kronik ağrı sendromu tanımlanmış, cerrahi tedavi ile klinik düzelme gözlenmiştir. 15 Ayrıca, Riley ve ark. yüksek hacimli EKY uygulamalarında kronik sakral ağrı, bir hastada L4-5 radikülopati, bir hastada S1 radikülopati bulguları tanımlamışlardır.…”

Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles

“…Only a handful of case reports have been published on the onset of CES following stab wounds, the administration of epidural anesthesia, and the spontaneous occurrence of epidural and subdural hematomas from anticoagulation therapy. 17,40,41 The unifying theme in all of these publications has been the concept of timely diagnosis and surgical decompression in the context of obvious thecal sac compression. Unfortunately, even with timely surgical intervention in these scenarios, functional outcome has often been unpredictable.…”

“…Although CES is clearly related to the presence of an acute large lumbosacral disc herniation, its relationship to acute traumatic injury to the thoracolumbar junction is less clearly defined. Many authors 2,3,14,17,18,22,27,34,36,40,41 have defined variable treatment algorithms for the management of CES caused by acute herniation of the nucleus pulposus. Nonetheless, a precise understanding of the pathophysiology and optimal treatments, including the timing of the latter, has yet to be elucidated for either traumatic CES or CMS.…”