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Case Report: Subdural Hematoma Following Spinal Catheter for a Ceserean-Section Requiring Emergency Neurosurgery
Abstract Type: Case Report/Case Series
Intracranial subdural hemorrhage (SDH) is a rare, but serious complication of neuraxial anesthesia. We present a parturient who developed a SDH after a spinal catheter requiring emergency neurosurgery.
A 33yo parturient presented with severe preeclampsia and labor was induced. After accidental dural puncture during an attempted epidural catheter placement, an intrathecal catheter was placed and an intrathecal infusion of ropivicaine was used for analgesia. The patient underwent a Cesarean-Section (CS) delivery and the catheter was removed immediately after surgery. On post-operative day 4,a MRI was obtained due to persistent headache, which showed a large intracranial subdural hematoma causing midline shift. The patient was immediately transferred to our higher acuity facility and subsequent imaging revealed increasing size of the subdural hematoma. She underwent emergency decompressive neurosurgery and was discharged home five days later without sequelae.
The differential for headaches in the post-partum patients is extensive, and includes tension headaches, post-dural puncture headaches, and in rare cases, subdural hematomas. Subdural hematomas in the post-partum period are thought to occur when leakage of cerebrospinal fluid(CSF) through a dural puncture is significant enough to cause intracranial contents to shift caudally. This caudal displacement causes tension and tearing of the bridging veins with resulting hematoma formation(1). Factors that can exacerbate CSF extrusion include large dural punctures and a prolonged second stage of labor. Our patient had a CS with no pushing trials, and also had an intrathecal catheter in place, which offers the theoretical advantage of partially occluding the dural puncture and decreased CSF leak. This case suggests that there may be other risk factors that predispose patients to CSF leak and subsequent neurosurgical consequences. It serves as a reminder to anesthesiologists to remain vigilant when considering post-partum patients with headaches, especially when associated with potential intracranial pathology(2).
1.Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psych 1984;47:121–7.
2.Cuypers, V, Van de Velde, M, Devroe, S. Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth 2016;25:58–65