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Postdural puncture subdural hematoma or postdural puncture headache?: two cases report.

Aydemir Kale1, Hakan Emmez2, Özcan Pişkin3

  • 1Department of Neurosurgery, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey.

Korean Journal of Anesthesiology
|October 24, 2015
PubMed
Summary

Postdural puncture headache (PDPH) following spinal anesthesia can mask subdural hematomas. Early suspicion and evaluation are crucial for diagnosing postdural puncture subdural hematoma (PDPSH) and preventing severe outcomes.

Keywords:
Postdural puncture headacheSpinal anesthesiaSubdural hematoma

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Neurology

Background:

  • Spinal anesthesia is a common anesthetic technique for various surgical procedures.
  • Postdural puncture headache (PDPH) is the most frequent complication of spinal anesthesia.
  • Subdural hematomas, often associated with trauma, carry significant morbidity and mortality.

Purpose of the Study:

  • To highlight the potential diagnostic challenge posed by PDPH in masking subdural hematomas.
  • To emphasize the importance of considering postdural puncture subdural hematoma (PDPSH) in patients with persistent or severe headaches post-spinal anesthesia.
  • To report cases of PDPSH following epidural anesthesia.

Main Methods:

  • Case report presentation of two patients experiencing bilateral subdural hematoma after epidural anesthesia.
  • Review of the clinical presentation and diagnostic considerations for differentiating PDPH from PDPSH.
  • Emphasis on clinical suspicion and appropriate diagnostic evaluation.

Main Results:

  • The study presents two cases of bilateral subdural hematoma occurring after epidural anesthesia.
  • Headaches following spinal anesthesia can obscure the diagnosis of subdural hematoma.
  • The true incidence of PDPSH is likely underestimated due to diagnostic challenges.

Conclusions:

  • Headache after spinal anesthesia necessitates careful evaluation to rule out serious complications like subdural hematoma.
  • Increased vigilance for PDPSH is warranted in patients presenting with specific headache patterns post-procedure.
  • Prompt diagnosis and management of PDPSH are critical for improving patient outcomes.