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Subdural hematoma after atraumatic spinal.

Ursula N Landman1, Roseline M Jerome, Peter S A Glass

  • 1Department of Anesthesiology, Stony Brook Health Sciences Center, School of Medicine, Stony Brook, NY 11794-8480, USA. ulandman@notes.cc.sunysb.edu

Journal of Clinical Anesthesia
|August 17, 2005
PubMed
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A rare subdural hematoma complication occurred after spinal anesthesia, initially mistaken for postdural puncture headache (PDPH). Early recognition and treatment are crucial, even without typical risk factors.

Area of Science:

  • Neurosurgery
  • Anesthesiology

Background:

  • Spinal anesthesia can lead to postdural puncture headache (PDPH).
  • Subdural hematoma is a rare but serious complication following spinal anesthesia.
  • Patients may self-treat PDPH, potentially masking or delaying diagnosis of other conditions.

Purpose of the Study:

  • To report a case of subdural hematoma in a patient who initially presented with postdural puncture headache after spinal anesthesia.
  • To highlight the importance of considering subdural hematoma in persistent headaches post-spinal anesthesia, even in the absence of typical risk factors.

Main Methods:

  • Case report of a 68-year-old male undergoing inguinal hernia repair with spinal anesthesia.
  • Patient developed postdural puncture headache (PDPH) and self-treated with analgesics.

Related Experiment Videos

  • Diagnosis of subdural hematoma was made on postoperative day 11.

    • Main Results:

    • The patient developed a subdural hematoma despite having no reported risk factors.
    • The subdural hematoma resolved without surgical intervention, with a normal CT scan at 49 days postoperatively.
    • The initial headache was presumed to be PDPH but evolved into a more serious condition.

    Conclusions:

    • Persistent headaches after spinal anesthesia should prompt consideration of subdural hematoma, not just PDPH.
    • Minimizing spinal needle size and pre-operative screening for anticoagulant use are recommended preventive measures.
    • Patients refusing invasive PDPH treatment must be counseled on subdural hematoma risks and advised against anticoagulant medications.