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Postpartum bilateral subdural hematomas following spinal anesthesia: case report
J E Cohen1, J Godes, B Morales
1Department of Neurosurgery, Hospital de Emergencias Dr. Clemente Alvarez, Rosario, Argentina.
Background:
Intracranial subdural hematoma is an exceptionally rare complication of spinal anesthesia. We report a case of this infrequent event and consider the influence of cerebral atrophy as a predisposing factor.
Methods And Results:
This 18-year-old woman with severe headaches was admitted to the hospital 42 days after delivery. She had a history of normal pregnancy and uneventful labor and delivery. The epidural anesthesia was satisfactory. Computed tomography showed bilateral chronic subdural hematomas that were surgically removed. An early follow-up scan showed marked resolution of the hematomas and a small sized brain with large subarachnoid space. A late follow-up scan confirmed the diagnosis of brain atrophy.
Conclusions:
Persistence of headache and gradual progression despite treatment must be regarded as a sign of intracranial complication following spinal anesthesia. In this case, cerebral atrophy is considered to be a contributory factor for the development of subdural hematoma following dural puncture.