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: A Case of Post- partum Sub Dural Hematoma ( SDH) : A Diagnostic Dilemma Following Epidural Analgesia… Is Epidural the Cause?
Abstract Number: RF5AH-188
Abstract Type: Case Report Case Series
Post-partum headaches are a common entity encountered in obstetric patients. In the setting of epidural analgesia, often the most common cause of headache is often attributed to be a PDPH.
Acute SDH is attributed to rupture of bridging cerebral veins. Predisposing factors could be a previous history of head trauma, decrease in CSF pressure with dural puncture, post-op hypotension and physiologic increase in venous pressure such as while coughing, defecating or pushing during a vaginal delivery.
We present a case of an essential prima gravida patient with previous history of head trauma and thoraco-lumbar spinal surgery who developed a headache after her delivery. She had an uneventful labor epidural for her vaginal delivery but did have a prolonged second stage of active labor. Four hours after her delivery, she complained of a significant headache. Although the headache was atypical and non-positional in nature it was initially assumed to be a PDPH. The symptoms were refractory to conservative management and was compounded by the patient’s refusal of certain medications. Due to severe persistent headache, neurology was consulted and an MRI was obtained which demonstrated bilateral subdural hematomas. Neurosurgery was consulted and non-surgical intervention was indicated.
In the setting of an epidural, the most common cause of headache is a often a PDPH. In the presence of an atypical postpartum headache following an uneventful epidural analgesia, the anesthesiologist should consider other intracranial etiologies and should seek immediate clinical and radiologic diagnoses.
We will discuss anesthetic consideration of this patient, the differential diagnosis of postpartum headache and the predisposing factors for a subdural hematoma.