Abstract
Postdural puncture headache is a well- known complication of spinal anesthesia, but the subsequent development of intracranial subdural hematoma is a serious life–threatening complication which should be urgently treated. We present the case of a 32-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 25-gauge Quincke spinal needle. After 48 hours she developed postdural puncture headache which was treated conservatively and she was discharged home. On the 30th day post operatively, the patient developed intracranial subdural hematoma which was surgically evacuated in the operating room and the patient had full recovery. Our report reviews the literature on 49 patients who developed a postdural puncture headache complicated by intracranial subdural hematoma following spinal anesthesia. Careful follow up and good communication between the anesthesiologist, the obstetrician and the neurosurgeon is essential for early diagnosis and management of possible subdural hematoma for patients developing a postdural puncture headache.
Highlights
Severe headache after spinal anesthesia in a pregnant patient has a broad differential diagnosis, including postdural puncture headache and intracranial pathologies [1]
Cerebral subdural hematoma is a serious life–threatening complication that may be misdiagnosed with postdural puncture headache [2]
We present a case that illustrates the importance of careful assessment of postspinal headache as it could be more serious than just benign postdural puncture headache
Summary
Severe headache after spinal anesthesia in a pregnant patient has a broad differential diagnosis, including postdural puncture headache and intracranial pathologies [1]. Cerebral subdural hematoma is a serious life–threatening complication that may be misdiagnosed with postdural puncture headache [2]. There was no history of hemorrhagic diathesis, use of anticoagulants or nonsteroidal anti-inflammatory drugs. Twenty-four hours after surgery the patient experienced frontotemporal postural headache, which was treated as postdural puncture headache with bed rest, intravenous hydration and simple analgesics. Her headache was continuous even when she was discharged from the hospital on the fourth postoperative day. A right fronto-temporal craniotomy was performed and the hematoma was evacuated Her symptoms resolved entirely and the patient did not develop any further symptoms. She was discharged home after one week and had uneventful postoperative course during her follow up for six months
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