Postpartum subdural hematoma following neuraxial anesthesia: A case report and review of literature

Abstract

A healthy 34 year old primigravida delivered by cesarean section due to arrest of labor. Spinal anesthesia was performed without any problem via 25 Gauge Quincke needle between L3-L4 interspace. Postpartum first day, the patient had a post-dural puncture headache which eased by bed rest, aggressive intravenous hydration, caffeine and theophylline. Low molecular weight heparin therapy (enoxaparin 40 mg/day) was administered for prophylaxis of venous thromboembolism. On the sixth postoperative day, the patient referred again with violent headache. Magnetic resonance imaging confirmed subacute bilateral fronto-parieto-temporal subdural hematomas measured 3.5 mm on the left hemisphere and 5 mm on the right hemisphere. The case managed conservatively and recovered completely. Our report reviews 63 cases which complicated by postpartum subdural hematoma due to neuraxial anesthesia. Subdural hematoma should be remembered in the presence of resistant headache, additional neurological symptoms and predisposing factors since early diagnose and treatment is life-saving.