Subdural hematoma after cesarean delivery without symptoms: a case report

Area of Science:

• Anesthesiology
• Neurosurgery
• Radiology

Background:

• Subdural hematoma (SDH) following accidental dural puncture (ADP) is a rare but potentially fatal complication.
• Combined spinal and epidural anesthesia presents unique challenges in managing potential neurological complications.
• The absence of typical headache symptoms can mask the development of serious intracranial pathology.

Purpose of the Study:

• To report a rare case of subdural hematoma (SDH) developing after combined spinal and epidural anesthesia.
• To emphasize the importance of considering neuroimaging in patients with atypical postoperative presentations following ADP.
• To highlight that subdural hematoma can occur without the classic symptom of severe headache.

Main Methods:

• A case presentation of a 41-year-old parturient undergoing cesarean delivery under combined spinal and epidural anesthesia.
• Postoperative monitoring revealed neck stiffness, prompting neuroimaging.
• Magnetic resonance imaging (MRI) and computed tomography (CT) were utilized for diagnosis and monitoring.
• Treatment involved an epidural blood patch.

Main Results:

• A 41-year-old female developed bilateral subdural hematoma after combined spinal and epidural anesthesia.
• The patient did not experience a significant headache, presenting initially with neck stiffness.
• Subdural hematoma size decreased following an epidural blood patch.
• The patient was discharged without further symptoms.

Conclusions:

• Subdural hematoma can occur following accidental dural puncture without the hallmark symptom of severe headache.
• Neuroimaging should be considered in patients with concerning neurological signs post-ADP, irrespective of headache.
• Early diagnosis and intervention, such as epidural blood patch, can lead to favorable outcomes.