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[Acute spinal subdural hematoma after attempted spinal anesthesia]
R Likar1, K Mathiaschitz, M Spendel
1Abteilung für Anästhesiologie, Arbeitsunfallkrankenhaus Klagenfurt.
Der Anaesthesist
|January 1, 1996
Summary
A rare subdural hematoma causing paraplegia occurred after an attempted spinal anesthesia in a 72-year-old woman. Despite prompt decompression, paralysis persisted, highlighting the need for vigilant neurological monitoring post-procedure.
Area of Science:
- Neurosurgery
- Anesthesiology
- Neurology
Background:
- Subdural hematomas are rare but serious complications following central neural blockade.
- Difficult anatomical conditions, such as obesity and spinal deformities, can increase procedural risks.
Purpose of the Study:
- To report a case of subdural hematoma and resulting paraplegia after an unsuccessful attempt at spinal anesthesia.
- To emphasize the importance of neurological monitoring after neuraxial procedures.
Main Methods:
- A 72-year-old woman underwent multiple attempts at spinal anesthesia due to challenging anatomy.
- General anesthesia was administered for femoral neck fracture repair.
- Postoperatively, paraparesis was noted, leading to radiological confirmation of a subdural hematoma and subsequent neurosurgical decompression.
Main Results:
- A subdural hematoma was discovered and evacuated, but the patient's paraplegia was irreversible.
- The suspected cause was puncture of a spinal nerve's accompanying vessel, possibly the artery of Adamkiewicz, during a paramedian approach.
Conclusions:
- Close neurological monitoring is crucial for at least 24 hours post-surgery, even after failed attempts at central neural blockade.
- This case underscores the potential for severe neurological deficits from vascular injury during neuraxial procedures.