Can a Subdural Hematoma Develop After Spinal Anesthesia Even if Warfarin is Stopped at the Appropriate Time? A Case...

Spinal anesthesia (SA) is a commonly used technique in urological surgery and is generally regarded as a reliable, safe, and effective method of anesthesia. However, non-traumatic spinal subdural hematomas (NTSSH) that develop following SA are extremely rare and potentially life-threatening complications if not diagnosed and treated promptly. This case report describes a 66-year-old male scheduled for holmium laser enucleation of the prostate. His medical history included mitral valve replacement, for which he was receiving oral warfarin 10 mg once daily. Fifty-two hours after receiving nontraumatic SA, the patient developed progressive motor weakness, urinary retention, and fecal incontinence. Clinical examination revealed complete motor paralysis below the T₁₀ level (0/0) and total sensory loss, including vibration, proprioception, pain, temperature, and touch. At the 72nd postoperative hour, magnetic resonance imaging revealed an NTSSH extending from the T₁₂ vertebral level to the filum terminale, compressing the spinal cord and cauda equina. Despite urgent surgical decompression, evacuation of the hematoma, and intensive medical management, no neurological recovery was observed. This case highlights the critical importance of thorough preoperative evaluation, a multidisciplinary approach, individualized patient management, vigilant postoperative monitoring, and the prompt diagnosis and treatment of rare but severe complications. Perioperative nurses play a vital role in caring for patients with NTSSH, contributing significantly to recovery, ensuring patient safety, and optimizing clinical outcomes.