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

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 a...

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Main Authors: Bulent Bakar, Esra Ozer, Ismail Hakki Tekkok
Format: Article
Language:English
Published: Sociedade Brasileira de Anestesiologia 2015-10-01
Series:Revista Brasileira de Anestesiologia
Subjects:
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942015000500417&lng=en&tlng=en
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author Bulent Bakar
Esra Ozer
Ismail Hakki Tekkok
author_facet Bulent Bakar
Esra Ozer
Ismail Hakki Tekkok
author_sort Bulent Bakar
collection DOAJ
description 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.
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spelling doaj.art-df0def023d234a629d72cc1b891a1f732022-12-21T17:59:36ZengSociedade Brasileira de AnestesiologiaRevista Brasileira de Anestesiologia1806-907X2015-10-0165541742010.1016/j.bjane.2013.07.002S0034-70942015000500417Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labourBulent BakarEsra OzerIsmail Hakki TekkokABSTRACTBACKGROUND 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942015000500417&lng=en&tlng=enAnestesia combinada raquiperiduralPartoHematoma subdural
spellingShingle Bulent Bakar
Esra Ozer
Ismail Hakki Tekkok
Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
Revista Brasileira de Anestesiologia
Anestesia combinada raquiperidural
Parto
Hematoma subdural
title Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
title_full Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
title_fullStr Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
title_full_unstemmed Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
title_short Life-threatening acute subdural haematoma after combined spinal-epidural anaesthesia in labour
title_sort life threatening acute subdural haematoma after combined spinal epidural anaesthesia in labour
topic Anestesia combinada raquiperidural
Parto
Hematoma subdural
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942015000500417&lng=en&tlng=en
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AT esraozer lifethreateningacutesubduralhaematomaaftercombinedspinalepiduralanaesthesiainlabour
AT ismailhakkitekkok lifethreateningacutesubduralhaematomaaftercombinedspinalepiduralanaesthesiainlabour