Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.07.002
Brazilian Journal of Anesthesiology
Clinical Information

Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour

Hematoma subdural agudo potencialmente fatal após anestesia combinada raqui-peridural em parto

Bulent Bakar; Esra Ozer; Ismail Hakki Tekkok

http://dx.doi.org/10.1016/j.bjane.2013.07.002 Braz J Anesthesiol, vol.65, n5, p.417-420, 2015
PDF English
PDF Português
Downloads: 0
Views: 929

Abstract

ABSTRACTBACKGROUND AND OBJECTIVES: Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal or epidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour.CASE REPORT: A 34-year-old, primigravid women with a gestation of 38 weeks underwent caesarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She underwent urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed an extradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal.CONCLUSIONS: As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur.

Keywords

Combined spinal-epidural anaesthesia, Labour, Subdural haematoma

Resumo

RESUMOJUSTIFICATIVA E OBJETIVOS: Apenas alguns relatos na literatura mencionaram a possibilidade de formação de hematoma subdural craniano associada à punção durante a raquianestesia ou anestesia epidural. O presente relato descreve um caso tão raro que foi diagnosticado como hematoma subdural agudo após anestesia combinada raqui-peridural usada em parto.RELATO DE CASO: Paciente primípara, 34 anos, com 38 semanas de gestação, submetida à cesariana sob anestesia combinada raqui-peridural, deu à luz um menino saudável. Após 32 horas do parto, a dor de cabeça moderada da paciente progrediu para dor de cabeça intensa associada a náusea e vômito e se complicou subsequentemente com crise convulsiva generalizada tônico-clônica e consequente letargia. Tomografia computadorizada do cérebro revelou hematoma subdural agudo do lado direito em região frontotemporoparietal (FTP) com edema cerebral difuso. A paciente foi submetida à craniotomia FTP de urgência e evacuação do hematoma. Tomografia computadorizada do crânio no pós-operatório precoce mostrou um sítio operatório limpo. Oito dias após a cirurgia do hematoma subdural, a paciente voltou a ficar letárgica e, dessa vez, a tomografia computadorizada revelou um hematoma extradural sob o retalho ósseo que exigiu outra cirurgia. Dois dias depois, a paciente recebeu alta hospitalar com classificação de desempenho Karnofsky de 90/100. Ao exame de acompanhamento, a paciente apresentou-se neurologicamente intacta e sua tomografia computadorizada e ressonância magnética estavam normais.CONCLUSÃO: Ao usar a anestesia combinada raqui-peridural deve-se ter em mente que dor de cabeça nem sempre significa dor de cabeça hipotensiva associada à raquianestesia e que uma complicação catastrófica de hematoma subdural também pode ocorrer.

Palavras-chave

Anestesia combinada raquiperidural, Parto, Hematoma subdural

References

Vaughan DJ, Stirrup CA, Robinson PN. Cranial subdural haematoma associated with dural puncture in labour. Br J Anaesth. 2000;84:518-20.

Kayacan N, Arici G, Karsli B,. Acute subdural haematoma after accidental dural puncture during epidural anaesthesia. Int J Obstet Anesth. 2004;13:47-9.

Bisinotto FM, Dezena RA, Fabri DC,. Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report. Rev Bras Anestesiol. 2012;62:88-95.

Norris MC, Grieco WM, Borkowski M,. Complications of labor analgesia: epidural versus combined spinal-epidural techniques. Anesth Analg. 1994;79:529-37.

Abbinante C, Lauta E, DiVenosa N,. Acute subdural intracra- nial hematoma after combined spinal-epidural analgesia in labor. Minerva Anestesiol. 2010;76:1091-4.

Sharma S, Halliwell R, Dexter M,. Acute subdural haematoma in the presence of an intrathecal catheter placed for the preven- tion of post-dural puncture headache. Anaesth Intensive Care. 2010;38:939-41.

Ramos-Aparici R, Segura-Pastor D, Edo-Cebollada L,. Acute subdural hematoma after spinal anesthesia in an obstetric patient. J Clin Anesth. 2008;20:376-8.

Zeidan A, Farhat O, Maaliki H,. Does postdural punc- ture headache left untreated lead to subdural hematoma? Case report and review of the literature. Middle East J Anesthesiol. 2010;20:483-92.

5dcdd07f0e88258767bf58f2 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections