Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000100012
Brazilian Journal of Anesthesiology
Clinical Information

Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso

Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report

Flora Margarida Barra Bisinotto; Roberto Alexandre Dezena; Daniel Capucci Fabri; Tania Mara Vilela Abud; Livia Helena Canno

Downloads: 1
Views: 1358

Resumo

JUSTIFICATIVA E OBJETIVOS: O hematoma subdural intracraniano é uma complicação rara após raquianestesia. O diagnóstico é muitas vezes difícil porque os sintomas iniciais são os mesmos da cefaleia pós-punção da dura-máter. O objetivo é relatar o caso de um hematoma subdural diag nosticado precocemente, após uma raquianestesia realizada com agulha de calibre fino e punção única. RELATO DO CASO: Paciente de 48 anos, ASA I, submetida a raquianestesia para cirurgia de correção de incontinência urinária. Foi realizada a raquianestesia com agulha 27G Quincke e punção única. A cirurgia foi sem intercorrências, e a paciente recebeu alta hospitalar. Após 48 horas da punção raquidiana, a paciente relatou cefaleia de início súbito, de forte intensidade, acometendo principalmente a região orbitária, mas também a região temporal, com melhora importante no decúbito dorsal e acompanhada de dois episódios de vômitos. Foi solicitada tomografia de crânio que revelou a presença de um hematoma subdural agudo frontotemporoparietal esquerdo. Foi indicado tratamento conservador com analgésicos, dexametasoma e hidantoína. Após 17 dias, apresentou quadro de cefaleia intensa, acompanhada de dormência e paresia do membro superior direito, e distúrbio da fala e comportamento. O hematoma foi drenado cirurgicamente. A paciente evoluiu bem sem sequelas. CONCLUSÕES: A cefaleia é a complicação mais frequente após raquianestesia e é considerada de evolução benigna. Faz com que diagnósticos potencialmente fatais, como o hematoma subdural, não sejam feitos em muitos casos, ou sejam tardios. Este caso descreve uma ocorrência rara, um hematoma subdural agudo após uma raquianestesia com agulha fina em uma paciente sem fatores de risco para sangramento

Palavras-chave

TÉCNICAS ANESTÉSICAS, Regional, subaracnoidea, Cefaleia

Abstract

BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spinal anesthesia was performed with 27G Quincke needle and single puncture. There was no unexpected event in the surgery and the patient was discharged. After 48 hours of spinal puncture, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus and followed by two vomiting episodes. A cranial tomography was requested and revealed the presence of an acute left frontotemporoparietal subdural hematoma. A conservative treatment with analgesics, dexamethasone and hydantoin was indicated. After 17 days, the patient had intense headache, followed by dormancy and paresis of right upper limb and speech and behavior disorders. The hematoma was surgically drained. The patient evolved well and without sequelae. CONCLUSIONS: Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding

Keywords

COMPLICAÇÕES, Hematoma, Hematoma, Subdural, Spinal, Anesthesia, Spinal, Postoperative Complications, Post-Dural Puncture Headache

References

Alilou M, Halelfadl S, Caidi A. Une nouvelle observation d'hematome sous-dural chronique intracrânien au décours d'une rachianesthésie. Ann Fr Anaesth Reanim. 2003;22:560-561.

Scott DB, Hibbard BM. Serious nonfatal complications associated with extradural block in obstetric practice. Br J Anaesth. 1990;64:537-541.

Imbelloni LE, Sobral MGC, Carneiro ANG. Cefaleia pós-raquianestesia e o desenho das agulhas: Experiência de 5050 casos. Rev Bras Anestesiol. 2001;51(1):43-52.

Gaiser R. Postdural puncture headache. Cur Opin Anesthesiol. 2006;19:249-253.

Mokri B. Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol. 2003;16:319-326.

Turnbull DR, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-729.

Mokri B, Hunter SF, Atkinson JLD. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology. 1998;51:786-790.

Grant R, Condon B, Hart I. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440-442.

Boezaart AP. Effects of cerebrospinal fluid loss and epidural blood patch on cerebral blood flow in swine. Reg Anesth Pain Med. 2001;26(50):401-406.

Han H, Tao W, Zhang M. The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography. Neuroradiology. 2007;49:169-175.

Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space?. J Neurol Neurosurg Psychiaty. 1984;47:121-127.

Bjarnhall M, Ekseth K, Bostrom S. Intracranial subdural haematoma: a rare complication following spinal anaesthesia. Acta Anaesthesiol Scand. 1996;40:1249-1251.

Kayacan N, Arici G, Kardhi B. Acute subdural haematoma after accidental dural puncture during epidural anaesthesia. Int J Obstet Anesth. 2004;13:47-49.

Amorim JA, Remígio DSCA, Damázio Filho O. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura. Rev Bras Anestesiol. 2010;60(6):620-629.

Katricioglu K, Aydin O, Ozkalanli MY. Cranial subdural haematoma: a rare complication of spinal anaesthesia. Eur J Anaesthesiol. 2009;26(9):793-795.

Acharya R. Chronic subdural haematoma complicating spinal anesthesia. Neurol Sci. 2005;25:348-350.

Contais E, Behnamou D, Petit D. Acute subdural hematoma following spinal anesthesia with a very small spinal needle. Anesthesiology. 2000;93(5):1354-1355.

Landman UM, Jerome RM, Glass PSA. Subdural hematoma after a traumatic spinal. J Clin Anesth. 2005;17:379-381.

Kelsaka E, Sarihasan B, Baris S. Subdural hematoma as a late complocation of spinal anesthesia. J of Surgical Anesthesiol. 2003;15(1):47-49.

Bisinotto FMB, Martins Sobrinho J, Augusto CM. Hematoma sub-dural encefálico após anestesia subracnóidea. Rev Bras Anestesiol. 1993;43(3):199-200.

Zeidan A, Farhat O, Maaliki H. Does postdural puncture headache left untreated lead to subdural hematoma?: Case report and review of the literature. M E J Anesth. 2010;20(4):483-492.

Dawley B, Hendrix A. Intracranial subdural hematoma after spinal anesthesia in a parturient. Obstet Gynecol. 2009;113(2):570-572.

Baldwin L, Galizia E. Bilateral subdural hematoma: a rare diagnostic dilemma following spinal anesthesia. Anaesth Intensive Care. 1993;21:120-121.

Acharya R, Chhabra SS, Ratra M. Cranial subdural haematoma after spinal anaesthesia. Brit J Anaesth. 2001;86(6):893-5.

5dd558230e88256f15c8fca7 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections