The development of
intracranial subdural hematoma after
spinal anesthesia is a rare and serious complication that can be fatal if untreated. Needle
puncture to the dura mater can cause leakage of cerebrospinal fluid, and lead to stretching and
rupture of the meningeal blood vessels with resultant
bleeding. A 24-year-old patient, with a completely normal history and laboratory analysis, has got a L4-5 level
spinal anesthesia well done at first try, using a Quinke 25 G needle and 12,5 mg
bupivacaine heavy. The first day after
spinal anesthesia, the patient started to have a
headache. He applied to another hospital where he received
conservative treatment with a diagnosis of post-spinal
headache. But, persistence of the
headache made the patient refer to our pain clinic. The
headache was located behind the left ear non-postural in nature, and was associated with
tinnitus. Emergency cranial computerized tomography was obtained and acute fronto-temporo-parietal
subdural hematoma was reported. After
spinal anesthesia, continued atypical
headache and presence of
tinnitus must alert against an underlying
subdural hematoma. Early diagnosis can be made by history of the patient combined with neurological and radiological imaging methods.