Document Detail

Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature.
MedLine Citation:
PMID:  21146058     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Revista brasileira de anestesiologia     Volume:  60     ISSN:  1806-907X     ISO Abbreviation:  Rev Bras Anestesiol     Publication Date:    2010 Nov-Dec
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-06-06     Revised Date:  2014-02-05    
Medline Journal Info:
Nlm Unique ID:  0401316     Medline TA:  Rev Bras Anestesiol     Country:  Brazil    
Other Details:
Languages:  eng; por; spa     Pagination:  620-9, 344-9     Citation Subset:  IM    
Copyright Information:
© 2010 Elsevier Editora Ltda. All rights reserved.
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MeSH Terms
Aged, 80 and over
Anesthesia, Spinal / adverse effects*
Hematoma, Subdural, Intracranial / etiology*
Middle Aged
Young Adult

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