Spinal Subdural Hematoma following Epidural Anesthesia

Area of Science:

• Neurology
• Anesthesiology
• Neurosurgery

Background:

• Spinal subdural hematomas are rare, avascular intraspinal lesions.
• They are uncommon complications of lumbar puncture for anesthesia, especially in patients without bleeding risks.

Observation:

• A 19-year-old female developed a large thoracolumbar spinal subdural hematoma after epidural anesthesia for cholecystectomy.
• This resulted in rapidly progressing paraplegia over two days post-surgery.
• The patient had no prior bleeding disorders or anticoagulant use.

Findings:

• The hematoma occurred despite no thecal sac violation during epidural anesthesia.
• Potential bleeding sources include injury to an interdural vein or subarachnoid bleed extravasation.
• Surgical evacuation via multilevel laminectomy led to satisfactory recovery after nine days.

Implications:

• Epidural anesthesia can precipitate spinal subdural hematomas even without direct dural puncture.
• Prompt neuroimaging is essential when neurological deficits arise post-procedure.
• Early surgical intervention for spinal subdural hematomas improves patient outcomes.