1
|
Tomala S, Savoldelli GL, Pichon I, Haller G. Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study. Int J Obstet Anesth 2023; 56:103925. [PMID: 37832391 DOI: 10.1016/j.ijoa.2023.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Post-dural puncture headache (PDPH) occurs in 0.38-6.3% of neuraxial procedures in obstetrics. Epidural blood patch (EBP) is the standard treatment but fails to provide full symptom relief in 4-29% of cases. Knowledge of the risk factors for EBP failure is limited and controversial. This study aimed to identify these risk factors. METHODS We performed a retrospective cohort study using electronic records of 47920 patients who underwent a neuraxial procedure between 2001 and 2018 in a large maternity hospital in Switzerland. The absence of full symptom relief and the need for further treatment was defined as an EBP failure. We performed univariate and multivariate analyses to compare patients with a successful or failed EBP. RESULTS We identified 212 patients requiring an EBP. Of these, 55 (25.9%) had a failed EBP. Signs and symptoms of PDPH did not differ between groups. While needle size and multiple pregnancies were risk factors in the univariate analysis, mostly those related to the performance of the EBP remained significant following adjustment. The risk of failure increased when the epidural space was deeper than 5.5 cm (OR 3.08, 95% CI 1.26 to 7.49) and decreased when the time interval between the initial dural puncture and the EBP was >48 h (OR 0.20, 95% CI 0.05 to 0.83). CONCLUSION Persistence of PDPH following a first EBP is not unusual. Close attention should be given to patients having their EBP performed <48 h following injury and having an epidural space located >5.5 cm depth, as these factors are associated with a failed EBP.
Collapse
Affiliation(s)
- S Tomala
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G L Savoldelli
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - I Pichon
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - G Haller
- Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Health Services Management and Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
| |
Collapse
|
2
|
Oumer KE, Aychew H, Daniel T, Mekete G, Belete KG, Negash TT. Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study. Ann Med Surg (Lond) 2023; 85:4703-4708. [PMID: 37811087 PMCID: PMC10552984 DOI: 10.1097/ms9.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patient's age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities. Objective This study assessed the incidence and associated factors of PDPH among patients who received spinal anaesthesia for orthopaedic procedures at the Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Methods Prospective cohort study design was employed using Consecutive sampling method among patients who received spinal anaesthesia for orthopaedics procedure at Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Data were collected by face to face interview and direct observation based on questionnaire. The data were entered to epidata 4.6 and analyzed by SPSS version 20 software. A total 95 patients aged 16-75 was participated in study. Those independent variable that were significant on binary logistic regression at P less than 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value less than 0.05. Result Ninety-five study participants were included in our study of which 19 (20%) had developed PDPH. Among patients who develop PDPH; 9.5% of the patients reported moderate pain while 10.5% experience mild PDPH and 80% of patient has no pain. The BMI and age were found to have significant association with PDPH [(P value 0.018, adjusted odds ratio 8.738, 95% CI, 1.461-52.269) and (P value 0.011, adjusted odds ratio 12.146, 95% CI, 1.753-84.170)], respectively) to PDPH. Conclusion and recommendation The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. The hospital management and the anaesthetists should minimize the magnitude of by strictly following different preventive strategies.
Collapse
Affiliation(s)
- Keder Essa Oumer
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Habtamu Aychew
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Tenbite Daniel
- Department of Anesthesia, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Mekete
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Kumlachew Geta Belete
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| | - Tadese Tamire Negash
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor
| |
Collapse
|
3
|
Lawrence H, Morton A. Postpartum complications following neuraxial anaesthesia for obstetric physicians. Obstet Med 2023; 16:142-150. [PMID: 37720002 PMCID: PMC10504890 DOI: 10.1177/1753495x221146329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/04/2022] [Indexed: 09/19/2023] Open
Abstract
Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.1 A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.2 Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.
Collapse
Affiliation(s)
- Heather Lawrence
- Obstetrics Department, Mater Health, Raymond Terrace, South Brisbane, Australia
| | - Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Australia
- Department of Medicine, University of Queensland, Herston, Australia
| |
Collapse
|
4
|
Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2023:rapm-2023-104817. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
Collapse
Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
| |
Collapse
|
5
|
Sultan N, Miran MS, Wooldridge D, Zia M. Post Dural Puncture Subdural Hematoma: A Rare Iatrogenic Complication of Neuraxial Anesthesia. Cureus 2023; 15:e40520. [PMID: 37461760 PMCID: PMC10350308 DOI: 10.7759/cureus.40520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Although post-dural puncture headache is a well-known complication of neuraxial anesthesia, subdural hematoma following epidural injection is a rare but potentially under-recognized complication. The following is the case of a young female patient with no significant past medical history who developed a persistent and severe headache following the introduction of epidural anesthesia for labor induction. Imaging demonstrated multiple small subdural hematomas with findings concerning intracranial hypotension. She eventually underwent a blood patch and reported immediate relief from her headache.
Collapse
Affiliation(s)
- Nadia Sultan
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| | | | - David Wooldridge
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| | - Mudassar Zia
- Internal Medicine, University of Missouri Kansas City, Kansas City, USA
| |
Collapse
|
6
|
Chandankhede AR, Thombre SD. When a Headache Means More: A Case Report of Acute Spontaneous Subdural Hematoma After Spinal Anesthesia for Caesarean Section. Cureus 2023; 15:e37917. [PMID: 37220432 PMCID: PMC10200024 DOI: 10.7759/cureus.37917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
This case report describes a 30-year-old woman who developed an acute spontaneous subdural hematoma (SDH) after receiving intraspinal anesthesia for a cesarean section, presenting with only headache as an initial symptom. The purpose of the report is to emphasize the importance of considering acute spontaneous SDH as a potential complication of intraspinal anesthesia in patients presenting with headache, even in the absence of other neurological deficits, and the need for prompt recognition and management of this condition, as early intervention can significantly improve outcomes. The report also highlights the importance of informed consent and patient education about the potential risks and benefits of different types of anesthesia during cesarean section. The discussion includes the pathophysiology of subdural hematoma after spinal anesthesia, potential causes of severe headache, and the importance of distinguishing between neurological symptoms of intracranial hypotension, post-dural puncture headache (PDPH), and subdural hematoma. The patient underwent burr hole evacuation after the subdural hematoma converted completely to chronic, with no neurological abnormality or recurrence till now.
Collapse
Affiliation(s)
| | - Snehal D Thombre
- Anesthesiology, Shree Siddheshwar Multispeciality Hospital, Dhule, IND
| |
Collapse
|
7
|
Xiang T, Zhang X, Wei Y, Feng D, Gong Z, Liu X, Yuan J, Jiang W, Nie M, Fan Y, Chen Y, Feng J, Dong S, Gao C, Huang J, Jiang R. Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review. Front Neurol 2022; 13:900145. [PMID: 35937065 PMCID: PMC9354981 DOI: 10.3389/fneur.2022.900145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.
Collapse
Affiliation(s)
- Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Dongyi Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yupeng Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
- *Correspondence: Rongcai Jiang
| |
Collapse
|
8
|
A Case Report of a Subdural Hematoma following Spinal Epidural prior to a Total Knee Arthroplasty. Case Rep Orthop 2022; 2022:7548593. [PMID: 35692943 PMCID: PMC9184218 DOI: 10.1155/2022/7548593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/29/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction This case report adds to current literature on management of a subdural hematoma following total knee arthroplasty and is particularly important as joint replacement moves into outpatient surgery centers where the orthopedic surgery team becomes the sole patient contact point. Case Presentation. A 66-year-old male presented to the emergency department five days after elective robotic-assisted left total knee arthroplasty performed with spinal epidural with the symptoms of a persistent nonpostural headache. CT of the head revealed a small bifrontal acute subdural hematoma. He was admitted for overnight monitoring as a precaution. No vascular abnormalities or underlying pathology was found on further advanced imaging. He was discharged the following morning after follow-up CT showed no focal changes. Magnetic resonance imaging (MRI) one month later confirmed resolution of the subdural hematoma. Conclusion Orthopedic surgeons should be aware of the signs and symptoms, as well as the risk factors for subdural hematomas following lumbar puncture, as it is a rare, but potentially life-threatening complication of spinal epidural.
Collapse
|
9
|
Al-Saadi T, Al-Kindi Y, Allawati M, Al-Saadi H. Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication. Surg J (N Y) 2022; 8:e98-e107. [PMID: 35252567 PMCID: PMC8894081 DOI: 10.1055/s-0042-1743525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction
Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning.
Aim
A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries.
Methods
A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed.
Results
A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%).
Conclusion
The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post–spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.
Collapse
Affiliation(s)
- Tariq Al-Saadi
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital- McGill University, Montreal, Canada.,Neurosurgery Department, Khoula Hospital, Muscat, Sultanate of Oman
| | - Yahya Al-Kindi
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Moosa Allawati
- Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Hatem Al-Saadi
- Department of General Surgery, Sohar Hospital, Sohar, Sultanate of Oman
| |
Collapse
|
10
|
Halalmeh DR, Sandio A, Adrian M, Moisi MD. Intracranial Subdural Hematoma Versus Postdural Puncture Headache Following Epidural Anesthesia: A Case Report. Cureus 2022; 14:e21824. [PMID: 35291537 PMCID: PMC8896838 DOI: 10.7759/cureus.21824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/05/2022] Open
Abstract
Headache is a relatively common complaint following dural puncture whether it is diagnostic (lumbar puncture) or unintentional (e.g., after epidural anesthesia). Although postdural puncture headache (PDPH) turns out to be the culprit in many cases, other serious etiologies should be ruled out such as postepidural intracranial subdural hematoma (PEISH). PEISH is usually overlooked because it is relatively rare and due to other frequent causes of headache (e.g., tension headache, migraine, and PDPH) being the main consideration. PEISH can be easily misdiagnosed as PDPH because of similar clinical manifestations. Herein, we report a case of this rare complication and demonstrate the major differences between PDPH and PEISH. This 27-year-old woman with intrauterine fetal death of dizygotic twins complained of severe headache immediately following receiving epidural anesthesia for labor induction. The patient was initially diagnosed with PDPH, and a blood patch was placed which provided complete resolution of the headache only for two days. Computed tomography of the brain revealed a small subdural hematoma over the left frontal convexity. Conservative management with close monitoring was recommended in this case due to the small size of the hematoma and absence of intracranial mass effect. An early follow-up CT scan showed complete and spontaneous resolution of the hematoma. In patients with recurrence or change in the pattern of the headache, persistence of headache despite treatment, and presence of neurological dysfunction following epidural anesthesia, suspicion of intracranial etiology must be raised. Therefore, knowledge of this condition and differentiating it from PDPH is necessary to avoid misdiagnosis and futile attempts of treatment.
Collapse
|
11
|
Chen L, Huang J, Zhang Y, Qu B, Wu X, Ma W, Li Y. Real-Time Ultrasound-Guided Versus Ultrasound-Assisted Spinal Anesthesia in Elderly Patients With Hip Fractures: A Randomized Controlled Trial. Anesth Analg 2021; 134:400-409. [PMID: 34724678 DOI: 10.1213/ane.0000000000005778] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditional landmark-guided spinal anesthesia can be challenging in elderly patients with hip fractures. Ultrasound assistance (USAS) and real-time ultrasound guidance (USRTG) techniques can facilitate lumbar neuraxial blocks. However, it remains undetermined which method is optimal for use in elderly patients. This study aimed to evaluate which technique was associated with a higher success rate of spinal anesthesia in elderly patients with hip fractures: USAS or USRTG technique. METHODS A total of 114 elderly patients (≥70 years of age) with hip fractures were randomly assigned to receive spinal anesthesia using either the USAS or USRTG technique. The primary outcome was the first-attempt success rate, analyzed using the χ2 test. Secondary outcomes included first-pass success rate, the number of needle attempts and passes, locating time, procedure time, total time, adverse reactions and complications, patient satisfaction, and procedural difficulty score. RESULTS The first-attempt success rate (80.7% vs 52.6%; 95% confidence interval [CI], for the difference, 11.6-44.6) and first-pass success rate (63.2% vs 31.6%; 95% CI for the difference, 14.2-49) were both significantly higher in the USAS compared with the USRTG group (both P = .001). The number of attempts (1 [1-1] vs 1 [1-3]; P = .001) and median passes (1 vs 3; P < .001) were both significantly lower in the USAS group than in the USRTG group. The USRTG group had a shorter locating time (175 seconds [129-234 seconds] vs 315 seconds [250-390 seconds]; P < .001) but a longer procedure time (488 seconds [260-972 seconds] vs 200 seconds [127-328 seconds]; P < .001) and total time (694 seconds [421-1133 seconds] vs 540 seconds [432-641 seconds]; P = .036). There were no significant differences between the 2 groups with regard to the adverse reactions and complications. More patients in the USAS group had a high satisfaction score of 3 to 5 (P = .008). Overall, anesthesiologists rated the USRTG group procedure as "more difficult" (P = .008). CONCLUSIONS In elderly patients with hip fractures, spinal anesthesia with the USRTG technique is not superior to the USAS technique since it has a lower success rate, longer procedure time, lower satisfaction score, and is more difficult to perform. So USAS technique may be more suitable for elderly patients.
Collapse
Affiliation(s)
- Luying Chen
- From the Guangzhou University of Chinese Medicine
| | | | - Yuling Zhang
- From the Guangzhou University of Chinese Medicine
| | - Bo Qu
- Department of Anesthesiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinyuan Wu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Wuhua Ma
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| |
Collapse
|
12
|
Bekele D, Bayable M, Bedane A. Chronic intracranial subdural hematoma after spinal anesthesia for a cesarean section: a case report. J Med Case Rep 2021; 15:492. [PMID: 34615533 PMCID: PMC8496000 DOI: 10.1186/s13256-021-03100-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background Subdural hematoma is a rare, potentially devastating, yet curable complication of spinal anesthesia. Differentiation between post-dural puncture headache and subdural hematoma can be difficult, resulting in a delay in diagnosis. Case presentation We present a 28-year-old Ethiopian female patient who underwent elective cesarean section under spinal anesthesia and returned to the emergency department after 1 month with a worsening headache. Brain computed tomography revealed a chronic subdural hematoma with a significant midline shift. The patient recovered completely after surgical evacuation. Conclusions A high index of suspicion and close attention to the pattern and characteristics of the headache, coupled with a meticulous neurologic examination and neuroimaging, can help to achieve timely diagnosis of this serious entity. Investigation with head computed tomography or magnetic resonance imaging is vital.
Collapse
Affiliation(s)
- Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia.
| | - Mehari Bayable
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 1271, Addis Ababa, Ethiopia
| | - Alemayehu Bedane
- Department of Radiology, Saint Paul's Hospital Millennium Medical College, P.O.Box - 143079, Addis Ababa, Ethiopia
| |
Collapse
|
13
|
Mathew GV, Shibli K, Korichi N, Thippeswamy VB. Sub-Dural Haematoma After Accidental Dural Puncture During Labour Epidural Analgesia. Cureus 2021; 13:e16915. [PMID: 34513488 PMCID: PMC8418350 DOI: 10.7759/cureus.16915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/04/2022] Open
Abstract
Inadvertent dural puncture with subsequent post-dural puncture headache (PDPH) is the most typical complication of labour epidural analgesia. Subdural hematoma (SDH) is a rare but late neurological complication of this procedure. The intracranial hypotension created by the cerebrospinal fluid (CSF) leakage through the dural defect can lead to the rupture of the bridging veins to produce a subdural hematoma. A change in the character from postural to a non-postural headache is a warning sign of subdural hematoma. We describe a case of post-dural puncture headache followed by the development of cranial SDH in a patient who refused a blood patch and opted for conservative treatment. We conclude that a high index of suspicion must be maintained with a witnessed dural puncture or even without it but having persistent headache, to detect any severe complications like an intracranial subdural hematoma. An epidural blood patch is to be considered when the headache does not subside with conservative management. Early employment of MRI or CT head imaging studies should be considered to exclude, diagnose, or treat any serious complication without unnecessary delay.
Collapse
|
14
|
Wijayanayaka S, Guha A, Sivanesan K, Veerasingham M. Extra-axial haemorrhage in a patient with Alport syndrome after epidural anaesthesia. BMJ Case Rep 2021; 14:e242160. [PMID: 34083183 PMCID: PMC8183280 DOI: 10.1136/bcr-2021-242160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/04/2022] Open
Abstract
Extra-axial haemorrhage following epidural anaesthesia is extremely rare. We present the case of an 18-year-old G1P0 woman with Alport syndrome who had a ventouse delivery for failure to progress that was complicated by a postpartum tonic-clonic seizure. Clinically, and confirmed radiologically, the patient was found to have experienced an extra-axial haemorrhage (extradural and subdural haemorrhage) secondary to a cerebrospinal fluid leak caused by a dural puncture during epidural anaesthesia. Differentiating between postdural puncture headache, subdural haemorrhage and extradural haemorrhage can be extremely challenging, but it is important to consider these rare conditions when evaluating patients presenting with postpartum headache and seizure.
Collapse
Affiliation(s)
- Shanika Wijayanayaka
- Department of Obstetrics & Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Abir Guha
- Department of Anaesthesia, Ipswich Hospital, Ipswich, Queensland, Australia
| | | | - Mayooran Veerasingham
- Department of Obstetrics & Gynaecology, Ipswich Hospital, Ipswich, Queensland, Australia
| |
Collapse
|
15
|
Acute thalamic haemorrhagic stroke after combined spinal-epidural anaesthesia in pregnancy: A case report. Eur J Anaesthesiol 2021; 37:828-829. [PMID: 32769514 DOI: 10.1097/eja.0000000000001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Pontes R, Junqueira F, Paiva M, Ferreira M, Oliveira N, Costa V. Intracranial subdural haematoma following dural puncture accidental: clinical case. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:103-106. [PMID: 32854941 DOI: 10.1016/j.redar.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
Intracranial subdural hematoma is a rare, but potentially lethal complication of neuraxial procedures. Considering the high frequency of neuraxial techniques in the obstetric population, parturients are more susceptible to this fearful complication. The diagnosis is often masked and delayed because it shares similar clinical characteristics with posdural puncture headache, with headache being the most common symptom. This case report describes a timely diagnosis and successful management of an intracranial subdural hematoma, after unintentional dural puncture during labour epidural analgesia. Postpartum headache following epidural analgesia, remains a clinical challenge for the caring team, requiring a close follow-up and awareness for non-benign causes that require prompt management, avoiding devastating consequences.
Collapse
Affiliation(s)
- R Pontes
- Departamento de Anestesiología, Centro Hospitalario Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - F Junqueira
- Departamento de Anestesiología, Centro Hospitalario Universitario de Lisboa Central, Lisboa, Portugal
| | - M Paiva
- Departamento de Anestesiología, Centro Hospitalario Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - M Ferreira
- Departamento de Anestesiología, Centro Hospitalario Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - N Oliveira
- Departamento de Anestesiología, Centro Hospitalario Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - V Costa
- Departamento de Anestesiología, Centro Hospitalario Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
17
|
Uyel Y, Kilicaslan A. Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial. Eurasian J Med 2020; 53:9-14. [PMID: 33716523 DOI: 10.5152/eurasianjmed.2020.20215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 01/20/2023] Open
Abstract
Objective This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery. Materials and Methods This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia. Results The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05). Conclusion Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.
Collapse
Affiliation(s)
- Yasin Uyel
- Department of Anaesthesiology and Reanimation, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Alper Kilicaslan
- Department of Anaesthesiology and Reanimation, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| |
Collapse
|
18
|
Moore AR, Wieczorek PM, Carvalho JCA. Association Between Post-Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma. JAMA Neurol 2020; 77:65-72. [PMID: 31524925 DOI: 10.1001/jamaneurol.2019.2995] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Women giving birth have high rates of dural puncture secondary to neuraxial anesthesia and are at high risk for a resulting headache. It appears to be unknown whether there is a significant association between post-dural puncture headache and subsequent intracranial subdural hematoma. Objective To determine the association of post-dural puncture headache with postpartum intracranial subdural hematoma. Design, Setting, and Participants This cohort study of patients used hospital discharges recorded in the US Agency for Healthcare Research and Quality National Readmission Database for women who experienced childbirth from January 2010 to December 2016. Patients were included if they had been admitted for childbirth, had 2 months of follow-up data, and did not receive a diagnostic lumbar puncture. Only the first delivery for a calendar year was studied. Data were analyzed from January 2018 to June 2019. Exposures Women with post-dural puncture headache associated with neuraxial anesthesia in the 2-month postpartum period were identified using International Classification of Disease (Ninth Edition and Tenth Edition) codes and were compared with those without post-dural puncture headaches. Main Outcome and Measures The primary outcome was intracranial subdural hematoma in the 2-month postpartum period. Secondary outcomes included in-hospital mortality and occurrence of neurosurgery. Results A total of 26 469 771 patients with 26 498 194 deliveries were included. Exclusion of repeated deliveries (n = 28 423), deliveries without 2 months of follow-up data (n = 4 329 621), and deliveries with diagnostic lumbar puncture (n = 9334) resulted in a final cohort of 22 130 815 patients and deliveries. For the cohort, the mean (SD) age was 28.1 (6.0) years, and there were 68 374 post-dural puncture headaches, for an overall rate of 309 (95% CI, 302-316) per 100 000. There were 342 cases of subdural hematoma identified, indicating a rate of 1.5 (95% CI, 1.3-1.8) per 100 000 women. Of these, 100 cases were in women with post-dural puncture headache, indicating a rate of 147 (95% CI, 111-194) hematoma cases per 100 000 deliveries in this subgroup. Post-dural puncture headache had an unadjusted absolute risk increase of 145 (95% CI, 117-174) subdural hematoma cases per 100 000 deliveries. After adjusting for confounders, post-dural puncture headache had an odds ratio for subdural hematoma of 199 (95% CI, 126-317; P < .001) and an adjusted absolute risk increase of 130 (95% CI, 90-169; P < .001) per 100 000 deliveries. Conclusions and Relevance The presence of presumed post-dural puncture headache after neuraxial anesthesia in childbirth, compared with no headache, was associated with a small but statistically significant absolute increase in the risk of being diagnosed with intracranial subdural hematoma. Further research is needed to establish if this association is causal for this rare outcome.
Collapse
Affiliation(s)
- Albert R Moore
- Department of Anesthesia, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
| | - Paul M Wieczorek
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jose C A Carvalho
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Bridwell RE, Larson NP, Baker M, Cibrario A, Oliver J. Postpartum Bilateral Subdural Hematomas: A Case Report. Cureus 2020; 12:e11191. [PMID: 33269122 PMCID: PMC7703702 DOI: 10.7759/cureus.11191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Postpartum headache is a common emergency department (ED) complaint in women following delivery. Though the majority of these headaches are due to primary headache disorders or postdural puncture headaches, life-threatening complications can occur. Both postpartum pre-eclampsia can occur as well as hypercoagulable and vascular disorders including stroke, venous sinus thrombosis (VST), and reversible cerebral vasoconstrictive syndrome. With the increasing use of epidurals for intrapartum analgesia, rare, dangerous complications can present in a similar fashion. The authors present a persistent postpartum headache secondary to bilateral subdural hematomas (SDH) from epidural induced intracranial hypotension.
Collapse
|
20
|
Ultrasound-assisted vs. landmark-guided paramedian spinal anaesthesia in the elderly. Eur J Anaesthesiol 2019; 36:763-771. [DOI: 10.1097/eja.0000000000001029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients. Can J Anaesth 2019; 66:1464-1471. [DOI: 10.1007/s12630-019-01486-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
|
22
|
Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch. Int J Obstet Anesth 2019; 38:104-118. [PMID: 30711239 DOI: 10.1016/j.ijoa.2018.12.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. Despite suffering long-term headaches, neither woman was adequately followed-up after discharge from hospital. Death resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the other. Due to significant variation in the treatment of obstetric post-dural puncture headache, an Obstetric Anaesthetists' Association working group was set up to produce evidence-based guidelines to guide clinicians. These guidelines have been condensed into two review articles. In this second review, the role of an epidural blood patch is discussed using a question and answer format.
Collapse
Affiliation(s)
- R Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - C Laxton
- Department of Anaesthetics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D N Lucas
- Department of Anaesthetics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - J Niewiarowski
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Scrutton
- Department of Anaesthetics, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - G Stocks
- Department of Anaesthetics, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
23
|
|
24
|
Ivanov E, Karadzova D, Doneva A, Nojkov J, Sivevski A. SUBDURAL HEMATOMA WITH SYMPTOMS OF EPILE PTIC ATTACKS AFTER SUBARACHNOIDAL ANESTHESIA – A CASE REPORT. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
25
|
Ioscovich A, Giladi Y, Fuica RL, Weiniger CF, Orbach‐Zinger S, Gozal Y, Shatalin D. Anesthetic approach to postdural puncture headache in the peripartum period: An Israeli national survey. Acta Anaesthesiol Scand 2018; 62:1460-1465. [PMID: 29971770 DOI: 10.1111/aas.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Accidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating. METHODS Following IRB approval, we conducted a national survey of the lead anesthesiologist in 23 labor and delivery rooms in Israel. Each survey inquired about medical center annual delivery volume, training program for residents, accidental dural puncture management, processing of information, and PDPH management strategies. RESULTS Data were collected from all 23 surveyed hospitals. As for methods for PDPH prevention, in most hospitals (87%) a prophylactic epidural blood patch (EBP) is not considered. Injection of epidural normal saline after delivery as a preventive measure is never considered in most (78.3%) hospitals, while four (17.4%) hospitals reported of constitutive use of this technique and one hospital only occasionally. Duration of conservative treatment was 24-48 hours in 95.7% of PDPH cases. CONCLUSION In this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48 hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.
Collapse
Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Yaara Giladi
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Rivka Leah Fuica
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Carolyn F. Weiniger
- Department of Anesthesiology and Critical Care Medicine Hadassah‐Hebrew University Medical Center Ein Kerem, Jerusalem, Israel and Division of Anesthesia, Critical Care and Pain Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Sharon Orbach‐Zinger
- Department of Anesthesia Rabin Medical Center (Beilinson Campus) Petah Tikvah, Tel Aviv University Tel Aviv Israel
| | - Yaacov Gozal
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| | - Daniel Shatalin
- Department of Anesthesiology Perioperative Medicine & Pain Treatment Shaare Zedek Medical Center affiliated with the Hadassah‐Hebrew University Medical School Ein‐Kerem Jerusalem Israel
| |
Collapse
|
26
|
De Lipsis L, Belmonte R, Cusano M, Giannetti MA, Muccio CF, Mancinelli M. Subdural Hematoma as a Consequence of Labor Epidural Analgesia. Asian J Neurosurg 2018; 13:931-934. [PMID: 30283586 PMCID: PMC6159069 DOI: 10.4103/ajns.ajns_115_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Subdural hematoma (SDH) following labor epidural analgesia is a rare neurological complication. SDH is a late complication of this procedure; it is caused by a leak of cerebrospinal fluid that may damage the vascular structures of the brain. Persistent headache in the days after labor epidural analgesia is a nonspecific clinical symptom caused by hematoma. Preexisting vascular malformations can be a concomitant cause of headache. Clinical cases have been reported even after epidural anesthesia. The differential diagnosis includes unspecified headache, sinusitis headache, drug-induced headache, cortical vein thrombosis, fistula of the dura mater, and bacterial, viral, and aseptic meningitis.
Collapse
Affiliation(s)
- Luca De Lipsis
- Department of Anesthesia, Sacred Heart of Jesus Hospital, Benevento, Italy
| | - Rossella Belmonte
- Department of Anesthesia, Sacred Heart of Jesus Hospital, Benevento, Italy
| | - Maria Cusano
- Department of Anesthesia, Sacred Heart of Jesus Hospital, Benevento, Italy
| | | | | | - Mauro Mancinelli
- Department of Radiology, Sacred Heart of Jesus Hospital, Benevento, Italy
| |
Collapse
|
27
|
Subdural hematoma after cesarean delivery without symptoms: a case report. JA Clin Rep 2018; 4:18. [PMID: 29497683 PMCID: PMC5820382 DOI: 10.1186/s40981-018-0151-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background Subdural hematoma (SDH) after accidental dural puncture (ADP) is rare but may be lethal. We experienced a patient who developed SDH after combined spinal and epidural anesthesia without a headache. Case presentation A 41-year-old parturient female with an unruptured cerebral aneurysm, was scheduled to undergo elective cesarean delivery. Cerebrospinal fluid leakage was identified during puncture of the epidural space, and a catheter was placed after re-puncture. The postoperative course was normal except for incisional pain. The patient complained of slight neck stiffness on the second postoperative day. Magnetic resonance imaging (MRI) was performed to ensure that there was no intracranial problem on the fourth postoperative day and showed a bilateral subdural hematoma. Increase in size of hematoma was shown on computed tomography (CT) on the ninth postoperative day. Epidural blood patch was performed. A decrease in the size of the hematoma was confirmed on the CT images on the 11th postoperative day, and the patient was discharged. The patient has not developed any additional symptoms. Conclusions We experienced a patient who developed a SDH without a remarkable headache. It may be better to perform brain imaging studies, even if the patient does not complain of headache.
Collapse
|
28
|
A dedicated lumbar puncture clinic: performance and short-term patient outcomes. J Neurol 2017; 264:2075-2080. [DOI: 10.1007/s00415-017-8597-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
|
29
|
Cranial nerve palsy following central neuraxial block in obstetrics – a review of the literature and analysis of 43 case reports. Int J Obstet Anesth 2017; 31:13-26. [DOI: 10.1016/j.ijoa.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 12/19/2022]
|
30
|
Chong S, Mohd Nikman A, Saedah A, Wan Mohd Nazaruddin W, Kueh Y, Lim J, Shamsul Kamalrujan H. Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass. Br J Anaesth 2017; 118:799-801. [DOI: 10.1093/bja/aex108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Singh S. Immediate onset of postdural puncture headache after spinal anesthesia. J Anaesthesiol Clin Pharmacol 2017; 33:134-135. [PMID: 28413296 PMCID: PMC5374823 DOI: 10.4103/0970-9185.168166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Swati Singh
- Department of Anaesthesia and Intensive Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
32
|
Neurologic complications in critically ill pregnant patients. HANDBOOK OF CLINICAL NEUROLOGY 2017. [PMID: 28190440 DOI: 10.1016/b978-0-444-63599-0.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Neurologic complications in a critically ill pregnant woman are uncommon but some of the complications (such as eclampsia) are unique to pregnancy and the puerperal period. Other neurologic complications (such as seizures in the setting of epilepsy) may worsen during pregnancy. Clinical signs and symptoms such as seizure, headache, weakness, focal neurologic deficits, and decreased level of consciousness require careful consideration of potential causes to ensure prompt treatment measures are instituted to prevent ongoing neurologic injury. Clinicians should be familiar with syndromes such as pre-eclampsia, eclampsia, stroke, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. Necessary imaging studies can usually be performed safely in pregnancy. Scoring systems for predicting maternal mortality are inadequate, as are recommendations for neurorehabilitation. Tensions can arise when there is conflict between the interests of the mother and the interests of the fetus, but in general maternal health is prioritized. The complexity of care requires a multidisciplinary and multiprofessional approach to achieve best outcome in an often unexpected situation.
Collapse
|
33
|
Onal O, Aslanlar E, Apiliogullari S, Erkocak OF, Celik JB. Hematoma subdural pós-espinal hiperagudo. Braz J Anesthesiol 2017; 67:110-112. [DOI: 10.1016/j.bjan.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
34
|
Iwase Y, Suzuki M, Bito H. A case report of intracranial hemorrhage after spinal anesthesia. JA Clin Rep 2017; 3:11. [PMID: 29492450 PMCID: PMC5813662 DOI: 10.1186/s40981-017-0081-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/01/2017] [Indexed: 11/15/2022] Open
Abstract
Background Chronic subdural hematoma (CSDH) after spinal anesthesia is a rare complication. We experienced a patient who developed CSDH after postdural puncture headache (PDPH) following combined spinal and epidural anesthesia (CSE). Case presentation A 38-week-gestation parturient with a history of previous cesarean delivery underwent elective cesarean section under CSE. She had been receiving aspirin therapy for Kawasaki disease for many years. She developed a symptom of PDPH 1 day after the surgery. Fluid administration and analgesics were started. Although the headache was relatively severe and persistent, it suddenly disappeared on the third postoperative day. Aspirin administration was restarted on the third postoperative day, and the patient was discharged 1 week after the surgery. 2 weeks after being discharged, she was readmitted to our hospital for severe headache and was diagnosed as having CSDH. An epidural blood patch was performed, resulting in resolution of the hematoma. Conclusions We experienced a case of CSDH after PDPH in a patient who was receiving aspirin therapy. Aspirin therapy should be restarted after confirmation of the absence of headache. We should consider the possibility of unexpected disappearance of PDPH in the postoperative period may be due to the development of CSDH.
Collapse
Affiliation(s)
- Yuri Iwase
- Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, 1-396 Kosugi-cho Nakahara-ku, Kawaski, Kanagawa 211-8533 Japan
| | - Manzo Suzuki
- Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, 1-396 Kosugi-cho Nakahara-ku, Kawaski, Kanagawa 211-8533 Japan
| | - Hiroyasu Bito
- Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, 1-396 Kosugi-cho Nakahara-ku, Kawaski, Kanagawa 211-8533 Japan
| |
Collapse
|
35
|
Onal O, Aslanlar E, Apiliogullari S, Erkocak OF, Celik JB. Post-spinal hyperacute subdural hematoma. Braz J Anesthesiol 2016; 67:110-112. [PMID: 28017163 DOI: 10.1016/j.bjane.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ozkan Onal
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey.
| | - Emine Aslanlar
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
| | - Seza Apiliogullari
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
| | - Omer Faruk Erkocak
- Selcuk University Medical Faculty, Department of Orthopedics and Traumatology, Konya, Turkey
| | - Jale Bengi Celik
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
| |
Collapse
|
36
|
Edlow AG, Edlow BL, Edlow JA. Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women. Emerg Med Clin North Am 2016; 34:943-965. [PMID: 27741996 DOI: 10.1016/j.emc.2016.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes. This article reviews the clinical features and differential diagnosis of acute serious neurologic conditions in pregnancy and the puerperium, focusing on diagnosis.
Collapse
Affiliation(s)
- Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mother Infant Research Institute, Tufts Medical Center, 800 Washington Street, Box 394, Boston, MA 02111, USA
| | - Brian L Edlow
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Place, West Clinical Center, 2nd Floor, Boston, MA 02215, USA.
| |
Collapse
|
37
|
Intravenous theophylline rapidly decreases post-lumbar puncture headaches. Acta Neurol Belg 2016; 116:337-9. [PMID: 26563407 DOI: 10.1007/s13760-015-0562-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/22/2015] [Indexed: 01/03/2023]
Abstract
When managing therapy for the post-lumbar puncture headaches (PLPHs), an efficacious, fast-acting, practical and safe method is preferred. Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches. The aim of this study was to highlight the brief initial time for a remarkable decrease of PLPH pain levels after the administration of IV theophylline infusion. We observed that IV theophylline infusion has a rapid and marked effect on decreasing pain in PLPHs. At 30 min of theophylline infusion, mean VAS levels were decreased by 47.1 % and at 60 min of infusion, the decrease of pain was 61.9 %. We conclude that IV theophylline infusion is a rapidly effective, noninvasive, practical and low-cost way to treat PLPHs. To the best of our knowledge, this is the first study to highlight both the efficacy and the speed of the effect of pain relief in PLPHs.
Collapse
|
38
|
|
39
|
Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth 2016; 25:58-65. [DOI: 10.1016/j.ijoa.2015.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
|
40
|
Subacute Intracranial Subdural Hematoma 40 Days After Spinal Anesthesia: A Case Report. ARCHIVES OF NEUROSCIENCE 2015. [DOI: 10.5812/archneurosci.25338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
41
|
Large intracranial subdural haematoma with midline shift following accidental dural puncture for labour analgesia. Int J Obstet Anesth 2015; 24:391-3. [DOI: 10.1016/j.ijoa.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/15/2015] [Accepted: 06/21/2015] [Indexed: 11/21/2022]
|
42
|
Kale A, Emmez H, Pişkin Ö, Durdağ E. Postdural puncture subdural hematoma or postdural puncture headache?: two cases report. Korean J Anesthesiol 2015; 68:509-12. [PMID: 26495064 PMCID: PMC4610933 DOI: 10.4097/kjae.2015.68.5.509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022] Open
Abstract
Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is unknown because most affected patients are probably managed without investigation. Therefore, the true incidence of PDPSH may be greater than suggested by previous reports. The differentiation of headache associated with subdural hematoma from PDPH is crucial. We herein report two cases of bilateral subdural hematoma after epidural anesthesia and emphasize the importance of suspicion for PDPSH and careful evaluation of patients with headache after spinal anesthesia.
Collapse
Affiliation(s)
- Aydemir Kale
- Department of Neurosurgery, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Hakan Emmez
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özcan Pişkin
- Department of Anesthesiology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Emre Durdağ
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
43
|
Hematoma subdural bilateral secundário a punção dural acidental. Braz J Anesthesiol 2015; 65:306-9. [DOI: 10.1016/j.bjan.2014.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 11/22/2022] Open
|
44
|
Ramírez S, Gredilla E, Martínez B, Gilsanz F. Bilateral subdural hematoma secondary to accidental dural puncture. Braz J Anesthesiol 2015; 65:306-9. [PMID: 26123149 DOI: 10.1016/j.bjane.2014.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/04/2014] [Indexed: 10/23/2022] Open
Abstract
We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.
Collapse
Affiliation(s)
- Sofía Ramírez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - Elena Gredilla
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Blanca Martínez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
45
|
Bisinotto FMB, Dezena RA, Abud TMV, Martins LB. [Cerebral venous thrombosis after spinal anesthesia: case report]. Rev Bras Anestesiol 2015; 67:305-310. [PMID: 25840468 DOI: 10.1016/j.bjan.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is a rare, but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia who had postoperative headache complicated with CVT. CASE REPORT Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged eight days without sequelae. DISCUSSION Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to TVC in some patients with prothrombotic conditions.
Collapse
Affiliation(s)
- Flora Margarida Barra Bisinotto
- Universidade Federal do Triângulo Mineiro, Disciplina de Anestesiologia, Uberaba, MG, Brasil; Universidade Federal do Triângulo Mineiro, Hospital de Clínicas, Uberaba, MG, Brasil.
| | | | | | | |
Collapse
|
46
|
Engedal TS, Ørding H, Vilholm OJ. Changing the needle for lumbar punctures. Clin Neurol Neurosurg 2015; 130:74-9. [DOI: 10.1016/j.clineuro.2014.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 12/15/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
|
47
|
Montasser MG. Post Dural Puncture Headache after Spinal Anesthesia for Caesarean Section: A Comparison of 27G Quincke and Whitacre Spinal Needles in Midline and Paramedian Approaches. JOURNAL OF MEDICAL SCIENCES 2014. [DOI: 10.3923/jms.2015.44.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
48
|
Affiliation(s)
- B M Scavone
- Department of Anesthesia & Critical Care and Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
49
|
Niraj G, Kelkar A, Girotra V. Greater occipital nerve block for postdural puncture headache (PDPH): A prospective audit of a modified guideline for the management of PDPH and review of the literature. J Clin Anesth 2014; 26:539-44. [DOI: 10.1016/j.jclinane.2014.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 11/26/2022]
|
50
|
Chia XX, Bazargan A. Subdural hemorrhage - a serious complication post-intrathecal chemotherapy. A case report and review of literature. Clin Case Rep 2014; 3:57-9. [PMID: 25678976 PMCID: PMC4317214 DOI: 10.1002/ccr3.147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/12/2014] [Accepted: 08/24/2014] [Indexed: 11/10/2022] Open
Abstract
We need to have a high index of suspicion for subdural hemorrhage (SDH) post-lumbar puncture in hematological patients given their increased risk and the significant morbidity and mortality associated with SDHs.
Collapse
Affiliation(s)
- Xiu Xian Chia
- Department of Haematology, St. Vincent's Hospital Melbourne, Australia
| | - Ali Bazargan
- Department of Haematology, St. Vincent's Hospital Melbourne, Australia
| |
Collapse
|