[Intracerebral hemorrhage after cesarean section under spinal anesthesia. Coincidence or causality?]

Intracerebral haemorrhage is a rare complication of spinal anaesthesia in obstetrics. A 37-year-old woman without any accompanying disease during a twin pregnancy, underwent an urgent caesarean section due to insufficiency of the placenta under spinal anaesthesia using hyperbaric bupivacain (0.5%) and a pencil-point spinal needle Sprotte 27 Gauge. The patient developed severe headache, a hemiparesis of the right upper limb and became somnolent and finally unconscious 80 min after the procedure. An immediately performed computed tomographic scan revealed a large acute intracerebral haemorrhage in the left hemisphere region with mass effect. The patient underwent temporoparietal craniotomy. No obvious cause of the haemorrhage, such as aneurysm or arteriovenous malformation was found. The patient fully recovered and was weaned from the respirator 32 h postoperatively. On postoperative day 7 the remaining neurologic deficits included aphasis and severe hemiparesis of the right upper limb and a right extensor plantar response. The neurologic status did not improve substantially until 6 months after the complication. The case and the recent literature are discussed.