Subdural hematoma after cesarean delivery without symptoms: a case report

Abstract

BackgroundSubdural hematoma (SDH) after accidental dural puncture (ADP) is rare but may be lethal. We experienced a patient who developed SDH after combined spinal and epidural anesthesia without a headache.Case presentationA 41-year-old parturient female with an unruptured cerebral aneurysm, was scheduled to undergo elective cesarean delivery. Cerebrospinal fluid leakage was identified during puncture of the epidural space, and a catheter was placed after re-puncture. The postoperative course was normal except for incisional pain. The patient complained of slight neck stiffness on the second postoperative day. Magnetic resonance imaging (MRI) was performed to ensure that there was no intracranial problem on the fourth postoperative day and showed a bilateral subdural hematoma. Increase in size of hematoma was shown on computed tomography (CT) on the ninth postoperative day. Epidural blood patch was performed. A decrease in the size of the hematoma was confirmed on the CT images on the 11th postoperative day, and the patient was discharged. The patient has not developed any additional symptoms.ConclusionsWe experienced a patient who developed a SDH without a remarkable headache. It may be better to perform brain imaging studies, even if the patient does not complain of headache.

Sub-Dural Haematoma After Accidental Dural Puncture During Labour Epidural Analgesia

“…The patient had not developed any additional symptoms. In this case, the authors suggest that a witnessed dural puncture with other allied symptoms, even in the absence of headache, may detect some seriously developing complications like a subdural hematoma in brain imaging studies [11].…”

Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases

“…Fifty-five of 101 patients diagnosed with PDPH were treated with an epidural blood patch (EBP) to alleviate the headache; 10 patients were treated without EBP, and this information was missing in the remaining patients. One patient without PDPH symptoms but with confirmed bilateral subdural hematoma was treated with an EBP to stop ongoing cerebrospinal fluid (CSF) leakage, 34 and one patient who was already treated twice with craniotomy for recurrent intracranial hematoma received an EBP because of ongoing CSF leakage from a lumbar drain site 35 ; both cases resulted in complete recovery. In the limited number of patients with reported data regarding the performance of an EBP and outcome, no differences were seen in terms of recovery (n=73, p=0.13).…”

Postpartum Bilateral Subdural Hematomas: A Case Report

“…An additional 20% will have diplopia or visual changes and 13% will demonstrate dysarthria or aphasia [7][8][9]. Interestingly, one case of postpartum SDH presented with neck stiffness but without headache, though this was after an elective cesarean delivery due to an unruptured cerebral aneurysm in the delivering mother [10].…”

“…The development of SDHs following epidural access is thought to be secondary to intraspinal and intracranial hypotension; in turn this causes ventricular collapse and caudal central nervous system migration, stretching the dura and tearing the bridging veins [ 10 , 14 ]. Early consultation to neurosurgery with admission to the intensive care unit for hourly neurologic assessments is key in managing these patients.…”