[Chronic subdural hematoma following spinal anesthesia]

A chronic subdural hematoma was observed 4 weeks after spinal anesthesia. The 70-year-old patient complained of severe, long-lasting headache soon after lumbar puncture. The later symptoms of hemiparesis and aphasia were first misinterpreted as a cerebral vascular accident. After evacuation of the hematoma the patient recovered. Long-lasting, severe headaches after lumbar puncture may be caused by a chronic subdural hematoma, a very rare complication. Risk groups are elderly patients and alcoholics, but every age group can be affected, including parturient women who deliver under spinal anesthesia. The diagnostic procedure of choice is computerized tomography (CAT). The application of contrast medium might be necessary if the CAT scan appears suspicious for a hematoma with the same density as the brain tissue. Because this complication is so rare informing the patient before spinal anesthesia does not seem to be necessary. According to expert opinions, a connection between lumbar puncture and subdural hematoma should be possible. In elderly patients and alcoholics, a pre-existing subdural hematoma may be possibly present.