Rare Complication of Spinal Anesthesia, Acute Subdural Hemorrhage: Case Report

Abstract

Acute subdural hemorrhage, following spinal anesthesia, is one of the rarest complication in obstetrics. Unless detected and treated early, it may lead to permanent disability and even maternal death. Post-dural puncture headache is the commonest cause of headache after spinal anesthesia. Severe and pronged headache, refractory to common analgesia, peripheral neurologic symptoms like weakness, mentation change and speech difficulty suggests subdural hemorrhage. Head imaging with CT or MRI is diagnostic. Conservative management or surgical intervention with burr hole and craniotomy are option of management depending on clinical severity and extent of hemorrhage. We present a case of 32 years old, gravida 3 para 2 mother, admitted to hospital and cesarean section was done for indication of previous two cesarean section scar at 39 week of gestation. Spinal anesthesia, Bupivacaine 2.5 mL, was administered using number a 24-gauge spinal needle at L3-L4 level. After 2 h of operation, she complained acute severe occipital headache, upper extremities paresthesia and neck pain. For these compliant, we consider post-dural puncture headache, the commonest cause of headache after spinal anesthesia, and administered her common analgesia. Despite adequate analgesia, headache worsen and developed difficulty of speech, intermittent lower extremity weakness and paresthesia and she became confused. All vital signs were stable and in normal range. On 5th post-operative day, she was evaluated by neurosurgeon and head MRI was taken. Head MRI indicates bilateral acute subdural hemorrhage on parietooccipital area. Amount of hemorrhage was significant and decide to operate the patient emergently. Bilateral Burr hole was done. Post-operative course was smooth. Post-operative course was smooth. She was appointed 2 weeks later for follow-up and her condition was stable. In conclusion, acute subdural hemorrhage is a rare post-spinal anesthesia complication. Clinicians should consider acute subdural hemorrhage in patients with prolonged headache and neurological symptoms after spinal anesthesia. Early diagnosis and intervention are essential to prevent permanent disability.

Keywords: burr hole; dural puncture; spinal anesthesia; subdural hemorrhage.