Bilateral chronic subdural hematomas with neurologic symptoms complicating spinal anesthesia

• Published in: Regional anesthesia and pain medicine Vol. 28; no. 4; pp. 347 - 350
• Main Authors: Slowinski, Jerzy, Szydlik, Wieslaw, Sanetra, Agata, Kaminska, Irena, Mrowka, Ryszard
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.07.2003; BMJ Publishing Group LTD
• Subjects: Abducens Nerve Injury - etiology; Adult; Anesthesia, Spinal - adverse effects; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Brain - pathology; Chronic Disease; Decompression, Surgical; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Diplopia - etiology; Female; Headache - etiology; Hematoma, Subdural, Chronic - etiology; Hematoma, Subdural, Chronic - pathology; Hematoma, Subdural, Chronic - surgery; Humans; Ligation; Magnetic Resonance Imaging; Nervous System Diseases - etiology; Nervous System Diseases - pathology; Nervous System Diseases - surgery; Neurologic complications; Regional anesthesia; Saphenous Vein; Spinal anesthesia; Subdural hematoma; Neurologic complications; Subdural hematoma; Spinal anesthesia
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1016/S1098-7339(03)00180-9

Background and Objectives: Intracranial subdural hematoma is a rare but potentially fatal complication of spinal anesthesia (SA). This case is intended to highlight the importance of careful follow-up of patients with a chronic headache that develops after SA. Case report: A 38-year-old woman underwent saphenous vein ligation for varices under SA. On the first postoperative day, she complained of severe postural headache that was controllable with oral analgesics. Two weeks later, bilateral abducens nerve palsy with diplopia developed. Brain magnetic resonance imaging (MRI) showed small bilateral subdural hygromas. Diplopia and headache (no longer postural) were relieved after administration of dexamethasone, but reappeared 6 wks later. This time, MRI showed large subdural hematomas. The patient was treated with burr-hole decompression. Conclusions: Persistent headache after SA requires careful neurologic and radiologic follow-up for exclusion of chronic intracranial bleeding. Pharmacologic treatment may mask some neurologic symptoms and delay diagnosis of intracranial complications related to SA.