A Rare Complication After Spinal Anesthesia: Intracranial Subdural Hematoma

Fatma Hançer Çelik; Necmi Baykan; Ömer Salt; Rukiye Aytekin; Gözde Yılmaz

doi:10.7197/cmj.1458402

EN TR

A Rare Complication After Spinal Anesthesia: Intracranial Subdural Hematoma

Abstract

Acute & chronic intracranial subdural hematoma is usually caused by trauma. However, it is a rare and serious complication after spinal anesthesia. A 38-year-old woman was brought to the emergency department by her relatives with complaints of sudden change in consciousness. It was learned that the patient gave birth by cesarean section under spinal anesthesia 3 days ago. It was anamnesized that there was no abnormality in the operation, the patient had a headache during the follow-up in the service and was diagnosed as post-dural puncture headache, analgesics were prescribed and she was discharged with recommendations. It was determined that the headaches continued after discharge and sudden change in consciousness occurred 2 hours after discharge. On physical examination, the patient was intubated because of poor general condition and Glasgow coma scale score of 8. The patient had 4/2 anisocoria on the left side. A brain CT scan showed a 6 mm subacute subdural hematoma in the left frontotemporoparietal region at the widest part. There was an 8 mm shift effect to the right of the midline, the sulci were obliterated and the cerebral tissue was mildly edematous. The patient was consulted to neurosurgery because of subacute subdural hematoma, shifting and anisocoria and was transferred to neurosurgery intensive care unit for emergency craniotomy and hematoma evacuation. This case report describes an acute subdural hematoma after spinal anesthesia and emphasizes that when using spinal anesthesia, it should be kept in mind that headache does not always mean hypotensive headache associated with spinal anesthesia and that a catastrophic complication of subdural hematoma may also occur.

Keywords

Spinal Anestezi Sonrası Nadir Bir Komplikasyon: İntrakraniyal Subdural Hematom

Öz

Akut ve kronik intrakraniyal subdural hematom genellikle travma nedeniyle oluşur. Ancak spinal anestezi sonrası nadir ve ciddi bir komplikasyondur. 38 yaşında kadın hasta yakınları tarafından ani bilinç değişikliği şikayeti ile acil servise getirildi. Hastanın 3 gün önce spinal anestezi altında sezaryen ile doğum yaptığı öğrenildi. Operasyonda herhangi bir anormallik olmadığı, hastanın servisteki takibi sırasında baş ağrısı olduğu ve post-dural ponksiyon baş ağrısı tanısı aldığı, analjezik reçete edildiği ve önerilerle taburcu edildiği öğrenildi. Taburcu olduktan sonra baş ağrısının devam ettiği ve taburcu olduktan 2 saat sonra ani bilinç değişikliği olduğu tespit edildi. Fizik muayenede genel durumu kötü ve Glasgow koma skalası skoru 8 olan hasta entübe edildi. Hastanın sol tarafında 4/2 anizokori vardı. Beyin BT taramasında sol frontotemporoparietal bölgede en geniş yerinde 6 mm subakut subdural hematom görüldü. Orta hattın sağına doğru 8 mm'lik bir kayma etkisi vardı, sulkuslar oblitereydi ve serebral doku hafif ödemliydi. Hasta subakut subdural hematom, şift ve anizokori nedeniyle beyin cerrahisine konsülte edildi ve acil kraniotomi ve hematom tahliyesi için beyin cerrahisi yoğun bakım ünitesine transfer edildi. Bu olgu sunumu spinal anestezi sonrası gelişen akut subdural hematomu tanımlamakta ve spinal anestezi kullanırken baş ağrısının her zaman spinal anesteziye bağlı hipotansif baş ağrısı anlamına gelmediğini ve subdural hematom gibi katastrofik bir komplikasyonun da oluşabileceğini akılda tutmak gerektiğini vurgulamaktadır.

Anahtar Kelimeler

References

1. Kshirsagar SJ, Pande AH, Naik SV, Kamble NM. Intracranial hypotension with subdural hematoma after spinal anesthesia in obstetric patient: A rare but fatal complication. Saudi J Anaesth. 2024;18(1):114-6.
2. Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. International Journal of Emergency Medicine. 2018;11:1-4.
3. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. International journal of obstetric anesthesia. 2008;17(4):329-35.
4. Apfel C, Saxena A, Cakmakkaya O, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. British journal of anaesthesia. 2010;105(3):255-63.
5. Vaughan D, Stirrup C, Robinson P. Cranial subdural haematoma associated with dural puncture in labour. British journal of anaesthesia. 2000;84(4):518-20.
6. Ferrari L, De Sevin F, Vigue J, Granry J, Preckel M, editors. Hématome sous-dural intracrânien après brèche dure-mérienne en obstétrique. Annales françaises d'anesthésie et de réanimation; 2001: Elsevier.
7. 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. International journal of obstetric anesthesia. 2016;25:58-65.
8. Nolte C, Lehmann T. Postpartum headache resulting from bilateral chronic subdural hematoma after dural puncture. The American journal of emergency medicine. 2004;22(3):241-2.

Details

Primary Language

English

Subjects

One Health

Journal Section

Case Report

Authors

Fatma Hançer Çelik
0009-0003-4421-5791
Türkiye

Necmi Baykan ^*
0000-0002-6845-9550
Türkiye

Ömer Salt
0000-0002-5557-6627
Türkiye

Rukiye Aytekin
0009-0007-7139-1562
Türkiye

Gözde Yılmaz
0009-0003-0032-4398
Türkiye

Publication Date

September 30, 2024

Submission Date

March 25, 2024

Acceptance Date

June 25, 2024

Published in Issue

Year 2024 Volume: 46 Number: 3

DOI

https://doi.org/10.7197/cmj.1458402

IZ

https://izlik.org/JA94ZP66GK

Cite

RIS / Bibtex

AMA

1.Hançer Çelik F, Baykan N, Salt Ö, Aytekin R, Yılmaz G. A Rare Complication After Spinal Anesthesia: Intracranial Subdural Hematoma. CMJ. 2024;46(3):205-207. doi:10.7197/cmj.1458402