Acute subdural intracranial hematoma after combined spinal-epidural analgesia in labor.

Abstract

Intracranial subdural hematoma is a rare, but well-described complication of epidural and spinal anesthesia, as documented by more than a decade of publications. Non-postural headache and vomiting are warning signs. A headache lasting more than 5 days should arouse suspicion of intracranial hemorrhage, whether or not it is associated with the appearance of neurological signs or the deterioration of neurological status. Urgent cranial computed tomography can confirm the diagnosis of subdural hematoma, which has the potential to cause a dramatic cerebral herniation syndrome. A combination of spinal epidural (CSE) anesthesia and analgesia is commonly used to obtain pain relief during caesarean sections and labor. We report the case of a patient who suffered from severe neurological deterioration and manifested signs of brain herniation due to the development of an acute intracranial subdural hematoma after CSE analgesia for labor. An emergency craniotomy was performed to remove the subdural hematoma and the patient recovered well. Close observation of patients undergoing CSE analgesia or anesthesia complaining of prolonged non-postural headaches, with or without neurological symptoms, is recommended.

• Authors: C Abbinante, E Lauta, N Di Venosa, M Ribezzi, A Colamaria, P Ciappetta
• Journal: Minerva anestesiologica (Minerva Anestesiol) Vol. 76 Issue 12 Pg. 1091-4 (Dec 2010) ISSN: 1827-1596 [Electronic] Italy
• PMID: 19202529 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Analgesia, Epidural (adverse effects)
• Analgesia, Obstetrical (adverse effects)
• Anesthesia, Spinal (adverse effects)
• Craniotomy
• Female
• Headache (etiology)
• Hematoma, Subdural, Acute (diagnosis, etiology, surgery)
• Humans
• Pregnancy
• Tomography, X-Ray Computed