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Acute Intracranial Subdural Hematoma Masquerading as a Postpartum Headache: A Case Report
Julie M Tondt1, Francis L Counselman2,3, Michael J Bono2,3
1Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania.
Clinical Practice and Cases in Emergency Medicine
|March 1, 2023
Summary
An acute subdural hematoma developed in a postpartum woman after epidural anesthesia. This rare complication, likely caused by cerebrospinal fluid leak and intracranial hypotension, resolved after a blood patch procedure.
Area of Science:
- Neurology
- Neurosurgery
- Obstetrics
Background:
- An acute subdural hematoma is a critical condition involving blood accumulation between the brain's dura and arachnoid membranes.
- While head trauma is the primary cause, spontaneous or iatrogenic cerebrospinal fluid (CSF) leaks leading to intracranial hypotension can also precipitate subdural hematomas.
Purpose of the Study:
- To report an unusual case of acute subdural hematoma in the postpartum period.
- To highlight a potential complication of epidural anesthesia for labor pain management.
Main Methods:
- A case report of a 26-year-old woman presenting with frontal headache post-vaginal delivery following epidural anesthesia.
- Diagnostic workup included computed tomography (CT) of the brain.
- Treatment involved a blood patch procedure.
Main Results:
- CT revealed an acute subdural hematoma in the left frontal cerebral hemisphere.
- The patient's symptoms completely resolved after the blood patch.
- The subdural hematoma was attributed to intracranial hypotension secondary to a CSF leak post-epidural anesthesia.
Conclusions:
- Acute subdural hematoma is a rare but possible complication of epidural anesthesia in the postpartum period.
- Intracranial hypotension resulting from a CSF leak is a potential mechanism for its development.
- Prompt diagnosis and intervention, such as a blood patch, can lead to complete symptom resolution.
