Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis

Abstract

SummaryUnrecognised dural punctures are difficult to diagnose early. Failure of recognition may lead to sinister consequences. A case of unrecognised dural puncture in a young female leading to the development of subdural hygroma and cortical vein thrombosis is presented. The dilemma in the diagnosis of headache in such patients along with the significance of follow‐up of all, including attempted, epidurals is also discussed.

Subdural hygroma accompanied by parenchymal and subarachnoid haemorrhage after epidural analgesia in an obstetric patient

“…Headache in pregnancy also includes pre‐eclampsia, migraine, drug‐induced headache and intracranial pathologies. Intracranial pathologies include subdural hygromas and hematomas, intracerebral haemorrhaging and venous sinus thrombosis . In the event of subdural hygromas or hematomas, which act as mass lesions, presentation may range from mild confusion and drowsiness to unstable gait, severe headache and grand mal convulsion …”

“…Other rare complications include subarachnoid and intraparenchymal bleeding, cortical vein thrombosis or intraspinal puncture combined with cerebral subarachnoid haemorrhaging . The emergence of a cranial subarachnoid haemorrhage after a postdural puncture is a rare complication with no clear production mechanisms, which are multifactorial.…”

“…During labour, she was monitored and no high arterial pressure was recorded. Infrequent intracranial subarachnoid haemorrhages after lumbar puncture are often associated with the breaking of intracranial aneurysms, arteriovenous malformations or vessel damage as a result of low intracranial pressure and traction of the brain in relation to arachnoid or perianaesthesia stress, whose pathogenesis is unclear . Although no arteriovenous malformations or aneurysms were found in the CCT or cranial MRI, the presence or absence of any vascular abnormalities cannot be confirmed because cerebral arteriography was not performed.…”

“…Very few reports describe intracranial haemorrhages after dural puncture and most are subdural hematomas. It was not possible to confirm if the subarachnoid and intraparenchymal haemorrhages were complications of postdural puncture by CSF hypotension, isolated hypertension, perianaesthesia stress, or if they were already existed …”

Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature

“…Usually it has a benign course, with most patients making complete recovery with or without an epidural blood patch (EBP). Rarely complications may develop in the form of subdural hygroma 6 and neurological deficits due to brainstem compression 7 . We present a case with PL headache in a post-partum female progressing to cerebral venous thrombosis (CVT).…”