| Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature. | |
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MedLine Citation:
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PMID: 21146058 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other 33 cases found on literature review. CASE REPORTS: In 35 patients (ages 20-88 years, 19 males), 14 were older than 60 years (40%), of which 12 (86%) were males. The relationship is inverted in the group of younger patients (< 60 years), in which we observed twice as many women (14:7). Two peaks of higher incidence were observed: 30-39 years (31%) and 60-69 years (29%). The length of time from the beginning of symptoms until diagnosis ranged from 4 hours to 29 weeks. Headache was the main complaint in 26/35 (74.3%) patients; changes in the level of consciousness in 14/35 (40.0%); vomiting in 11/35 (31,4%); hemiplegia or hemiparesis in 8/35 (22.9%); diplopia or VI nerve paresis in 5/35 (14.3%); and language disorders in 4/35 (11.4%). Contributing factors included: pregnancy, multiple punctures, use of anticoagulants, intracranial vascular abnormalities, and brain atrophy. In 15 cases, a contributing factor was not mentioned. Four out of 35 patients (11.4%) remained with neurologic sequelae, and 4/35 (11.4%) died. CONCLUSIONS: The presence of any of the signs or symptoms mentioned above should alert for the possibility of an intracranial subdural hematoma as a complication of puncture of the dura mater, especially in those patients with PDPH for more than one week, at which time investigation by neuroimaging is necessary. |
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Authors:
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Jane Auxiliadora Amorim; Diana Souza Canuto Dos Anjos Remígio; Otávio Damázio Filho; Marcos Aureliano Guerra de Barros; Valentina Nicole Carvalho; Marcelo Moraes Valença |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Revista brasileira de anestesiologia Volume: 60 ISSN: 1806-907X ISO Abbreviation: Rev Bras Anestesiol Publication Date: 2010 Nov-Dec |
Date Detail:
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Created Date: 2010-12-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401316 Medline TA: Rev Bras Anestesiol Country: Brazil |
Other Details:
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Languages: eng Pagination: 620-9 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Editora Ltda. All rights reserved. |
Affiliation:
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Anesthesiologist, Master's Degree in Neurosciences from Universidade Federal de Pernambuco (UFPE), Coresponsible for the CET/SBA HR, HGV e HOC), Recife-PE. |
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