Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.07.017
Brazilian Journal of Anesthesiology
Clinical Information

Bilateral subdural hematoma secondary to accidental dural puncture

Hematoma subdural bilateral secundário a punção dural acidental

Sofía Ramírez; Elena Gredilla; Blanca Martínez; Fernando Gilsanz

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Abstract

We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

Keywords

Accidental dural puncture, Epidural analgesia, Post-dural puncture headache, Subdural hematoma, Epidural blood patch

Resumo

Apresentamos o caso clínico de uma paciente de 25 anos na qual uma técnica peridural foi aplicada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido à ausência de melhoria clínica e à mudança do componente postural da cefaleia, decidiu-se fazer um exame de imagem cerebral que demonstrou a presença de hematoma subdural bilateral. A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, deve levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente.

Palavras-chave

Dura-máter, Analgesia epidural, Cefaleia pós-punção dural, Hematoma subdural, Placa de sangue epidural

References

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