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Goyal S, Lamba N, Dhal S, Makkar R, Sarna S. A prospective cross-sectional study to analyze the effect of transnasal sphenopalatine ganglion block in carcinoma buccal mucosa patients. ACTA MEDICA INTERNATIONAL 2022. [DOI: 10.4103/amit.amit_58_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Bos EM, van der Lee K, Haumann J, de Quelerij M, Vandertop WP, Kalkman CJ, Hollmann MW, Lirk P. Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases. Reg Anesth Pain Med 2021; 46:337-343. [PMID: 33441431 PMCID: PMC7982926 DOI: 10.1136/rapm-2020-102154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Besides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear. OBJECTIVE This review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block. EVIDENCE REVIEW We systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie. FINDINGS We analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found. CONCLUSION Diagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.
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Affiliation(s)
- Elke Me Bos
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Koen van der Lee
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Marcel de Quelerij
- Anesthesiologie, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Cor J Kalkman
- Anesthesiology, UMC Utrecht, Utrecht, The Netherlands
| | - Markus W Hollmann
- Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Philipp Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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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.
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Rosario LE, Rajan GR. Repeat Subdural Hematoma After Uncomplicated Lumbar Drain Discontinuation: A Case Report. A A Pract 2020; 13:107-109. [PMID: 30907750 DOI: 10.1213/xaa.0000000000001005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lumbar drains are commonly placed to monitor spinal cerebrospinal fluid (CSF) pressures and drain CSF to augment spinal cord perfusion. Excessive CSF drainage or persistent leakage through the dural puncture site can lead to cerebral hypotension and creation of an intracranial subdural hematoma. Anesthesia providers need to be aware of the risk of subdural hematoma development after major thoracoabdominal surgery where placement and subsequent removal of a lumbar drain have occurred. We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.
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Affiliation(s)
- Lauren E Rosario
- From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
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5
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Postdural puncture headache in obstetric patients. Br J Gen Pract 2019; 69:207-208. [PMID: 30923161 DOI: 10.3399/bjgp19x702125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 01/03/2023] Open
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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.
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Epstein NE. Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections. Surg Neurol Int 2017; 8:60. [PMID: 28540126 PMCID: PMC5421209 DOI: 10.4103/sni.sni_38_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/21/2022] Open
Abstract
Background: Various types of lumbar dural punctures may contribute to neurological injury. The etiologies of dural injury include; inadvertent dural punctures due to epidurals placed for labor anesthesia, epidural steroid injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the US per year), deliberate placement of intradural pain devices, and spontaneous cerebrospinal fluid (CSF) fistulas. Resulting neurological complications may include; spinal headaches/intracranial hypotension, subdural hematomas, and 6th nerve cranial palsies. Furthermore, uniquely in the cervical spine, inadvertent cervical dural punctures attributed to cervcial ESI (CESI) may lead to intramedullary spinal cord injuries (e.g. resulting in monoparesis to quadriplegia) or spinal cord strokes due to intravascular/vertebral artery injections. Methods/Results: In 8 studies, inadvertent lumbar dural punctures contributed to intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. In 5 of the 6 studies, inadvertent dural punctures occurring during CESI were responsible for intramedullary spinal cord injuries, or direct intravascular/vertebral injections resulting in monoplegia/quadriplegia. Conclusions: Inadvertent lumbar dural punctures led to multiple neurological complications including intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. Uniquely, inadvertent cervical dural punctures solely due to CESI directly resulted in intramedullary spinal cord injuries or cord stroked and monoplegia/quadriplegia attributed to intravascular/vertebral artery injections. The potential neurological risks/complications/adverse events attributed to lumbar and cervical ESI must be taken into account before spine surgeons and others order these procedures.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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8
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Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 2016; 34:194-6. [DOI: 10.1016/j.jclinane.2016.04.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022]
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McDougall RJ, Barnes R, Danks RA, Ditchfield M. Subdural haematoma following infant spinal anaesthesia. Childs Nerv Syst 2016; 32:579-81. [PMID: 26255150 DOI: 10.1007/s00381-015-2862-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Subdural haematoma (SDH) is rare following spinal anaesthesia and has not been reported previously in an infant. Non-accidental injury is the commonest cause of subdural haematoma in infants. METHODS We describe two cases of SDH following spinal anaesthesia in infants. RESULTS In both cases, forensic investigation was commenced and no evidence of child abuse was found. Both children are well 2 years after diagnosis. CONCLUSION Paediatric health workers should be aware of the possibility of SDH after spinal anaesthesia and consider this as a differential diagnosis when investigating possible non-accidental injury in an infant.
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Affiliation(s)
- Robert J McDougall
- Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Australia.
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, VIC, Australia.
| | | | - R Andrew Danks
- Department of Surgery, Monash University, Clayton, Australia
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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]
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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]
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12
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Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med 2015; 33:1714.e1-2. [DOI: 10.1016/j.ajem.2015.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
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13
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Richa F, Chalhoub V, El-Hage C, Dagher C, Yazbeck P. Subdural hematoma with cranial nerve palsies after obstetric epidural analgesia. Int J Obstet Anesth 2015; 24:390-1. [PMID: 26303755 DOI: 10.1016/j.ijoa.2015.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/19/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
Affiliation(s)
- F Richa
- Anesthesia and Intensive Care Department, Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - V Chalhoub
- Anesthesia and Intensive Care Department, Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - C El-Hage
- Anesthesia and Intensive Care Department, Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - C Dagher
- Anesthesia and Intensive Care Department, Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - P Yazbeck
- Anesthesia and Intensive Care Department, Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
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Møller A, Bjerrum OW, Afshari A. Haemostasis and safety measures before lumbar puncture in the haematology ward: the Danish routines. Acta Haematol 2014; 133:108-12. [PMID: 25247257 DOI: 10.1159/000362357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Thrombocytopenia and the increasing use and variety of antithrombotic drugs is a challenge prior to lumbar puncture. This study examined the Danish haematology practice regarding drug pausation, assessment of haemostasis and whether fundoscopy is a routine safety measure. METHODS An online survey with questions pertaining to precautions of haemostasis and application of fundoscopy was sent by e-mail to all 12 haematology wards in Denmark. RESULTS Eleven sites participated. Five (45%) reported no pausation of antiplatelet drugs at all. The mean platelet limit prior to lumbar puncture was 50 × 10(9)/l (range 10-50 × 10(9)/l). Seven (64%) sites had an international normalised ratio limit of 1.5, and the remaining 4 had values between 1.0 and 2.5. Two (18%) reported occasional use of thromboelastography or platelet analysis to assess the bleeding risk. Fundoscopy is routinely performed in 4 (36%) departments. CONCLUSION We report considerable variation in the routine handling of antithrombotics and thrombocytopenia in patients set for lumbar puncture in Danish haematology departments. The diversity may be explained by and related to different opinions in the literature. Common national guidelines are warranted and there is a need for studies to establish an evidence-based approach for the management of patients at risk of bleeding when lumbar puncture or another invasive procedure is indicated.
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Affiliation(s)
- Anders Møller
- Department of Anaesthesia, Slagelse Sygehus, Slagelse, Denmark
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Ajith VV, Shetty N, Paul C, Reddy P. Utility of neuroimaging in postpartum headache work-up: case report and diagnostic considerations. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- VV Ajith
- Department of Anaesthesiology, Kasturba Medical College, Manipal, India
| | - N Shetty
- Department of Anaesthesiology, Kasturba Medical College, Manipal, India
| | - C Paul
- Department of Anaesthesiology, Amala Institute of Medical Sciences, Trichur, India
| | - P Reddy
- Department of Anaesthesiology, Kasturba Medical College, Manipal, India
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Rucklidge OM. All patients with a postdural puncture headache should receive an epidural blood patch. Int J Obstet Anesth 2014; 23:171-4. [DOI: 10.1016/j.ijoa.2013.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 12/13/2022]
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Subdural hematoma following labor analgesia utilizing an intrathecal catheter. J Anesth 2013; 28:302-3. [DOI: 10.1007/s00540-013-1682-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Nepomuceno R, Herd A. Bilateral Subdural Hematoma after Inadvertent Dural Puncture during Epidural Analgesia. J Emerg Med 2013; 44:e227-30. [DOI: 10.1016/j.jemermed.2012.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/22/2012] [Accepted: 06/30/2012] [Indexed: 10/27/2022]
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20
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Zupan Z, Sotosek Tokmadzić V, Matanić-Manestar M, Sustić A, Antoncić I, Dunatov S, Pavlović I, Antulov R. Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report. Croat Med J 2012; 53:379-85. [PMID: 22911532 PMCID: PMC3428826 DOI: 10.3325/cmj.2012.53.379] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/07/2012] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening.
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Affiliation(s)
- Zeljko Zupan
- Department of Anaesthesiology, Reanimatology and Intensive care, Medical Faculty Rijeka, University of Rijeka, Tome Strizica 3, 51 000 Rijeka, Croatia.
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Acupuncture for postdural puncture headache: Report of two cases. Chin J Integr Med 2012; 19:546-8. [DOI: 10.1007/s11655-012-1057-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Indexed: 11/27/2022]
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Barbosa FT. [Post-dural headache with seven months duration: case report]. Rev Bras Anestesiol 2011; 61:355-9. [PMID: 21596196 DOI: 10.1016/s0034-7094(11)70042-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 12/13/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Post-dural puncture headache is a possible and expected complication in a small percentage of cases after spinal anesthesia. The objective of the current report was to describe the therapeutic conduct in a case of post-dural puncture headache with seven months of evolution. CASE REPORT A 40-year-old healthy female who complained of headache for seven months, which began after spinal anesthesia. She reported that some analgesics and decubitus position provided partial pain relief. An epidural blood patch was performed, with complete resolution of pain. She was discharged without complaints. CONCLUSIONS This case demonstrated that the epidural blood patch was effective in the treatment of chronic post-dural puncture headache in a case with seven-month evolution.
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Abstract
BACKGROUND Cutting needles remain the most commonly used needle design for lumbar puncture in the neurology community, although atraumatic (noncutting) needles have become common and popular for anesthesiologists performing spinal anesthesia. REVIEW SUMMARY The use of atraumatic spinal needles for lumbar puncture has been shown to significantly reduce the incidence of postdural puncture headache compared with cutting needles, without loss of efficacy or ease of use. CONCLUSION The use of noncutting or pencil-point spinal needles should become the standard for performing diagnostic lumbar puncture.
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Apoplejía de adenoma hipofisario no funcionante tras anestesia espinal. A propósito de dos casos. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70150-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Birnbach DJ, Ranasinghe JS. Anesthesia complications in the birthplace: is the neuraxial block always to blame? Clin Perinatol 2008; 35:35-52, vii. [PMID: 18280874 DOI: 10.1016/j.clp.2007.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article highlights the common and some of the very serious complications that may occur following neuraxial analgesia for labor and delivery, including headache, backache, infection, hypotension, and hematoma. Total spinal and failed block also are discussed, as are complications unique to epidural anesthesia, such as the intravascular injection of large volumes of local anesthetic (causing seizure or cardiac arrest) and accidental dural puncture.
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Affiliation(s)
- David J Birnbach
- Department of Anesthesiology, University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Tafer N, Perrier V, Racioppi L, Biais M, Quinart A, Revel P, Sztark F. [Cranial subdural haematoma after spinal anaesthesia treated by blood patch]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2008; 27:160-162. [PMID: 18160248 DOI: 10.1016/j.annfar.2007.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 11/13/2007] [Indexed: 05/25/2023]
Abstract
The authors report a case of subdural haematoma after spinal anaesthesia. A 36-year-old woman underwent phlebectomy under spinal anaesthesia. Two days later, she complains of severe headache without neurological signs, not responding to bed rest and analgesics. Magnetic resonance imaging showed a small acute subdural haematoma in the right parieto-occipital region. On the forth day, she was given a blood-patch, which improved rapidly the patient. Recovery was complete.
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Affiliation(s)
- N Tafer
- Service d'anesthésie-réanimation-I, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
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Subramaniam B, Panzica PJ, Pawlowski JB, Ramanavarapu V, Pomposelli FB, De La Torre R, Lerner AB. Epidural Blood Patch for Acute Subdural Hematoma After Spinal Catheter Drainage During Hybrid Thoracoabdominal Aneurysm Repair. J Cardiothorac Vasc Anesth 2007; 21:704-8. [PMID: 17905278 DOI: 10.1053/j.jvca.2006.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Indexed: 11/11/2022]
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Ozdemir O, Calisaneller T, Yildirim E, Altinors N. Acute Intracranial Subdural Hematoma After Epidural Steroid Injection: A Case Report. J Manipulative Physiol Ther 2007; 30:536-8. [PMID: 17870423 DOI: 10.1016/j.jmpt.2007.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 04/23/2007] [Accepted: 05/03/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Conservative treatment of lumbar radiculopathy includes bed rest, oral medications, physical therapy, spinal manipulation, mobilization, and epidural steroid injections. Intracranial subdural hematoma after accidental dural puncture is a rare and life-threatening complication of epidural steroid injections. In this report, we present a case of subacute intracranial subdural hematoma that developed after epidural steroid injection. CLINICAL FEATURES A 40-year-old man was admitted to our clinic with severe persistent headache and vomiting for 2 days after epidural steroid injection for right leg pain. INTERVENTION AND OUTCOME The patient was hospitalized for epidural steroid injection for right leg pain in our pain clinic and was discharged the same day. Twenty-four hours later, he started having a headache. Despite the use of oral analgesics, his headache worsened, and he began to vomit particularly in the upright position. Magnetic resonance imaging of the brain displayed a right frontal subdural hematoma. The headache was relieved after strict bed rest, intravenous hydration, and analgesics. The patient was discharged with full recovery after 1 week. CONCLUSION Intracranial subdural hematoma after accidental dural puncture during epidural steroid injection is a rare complication. Persistent headache should be evaluated carefully for possible intracranial hematomas.
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Affiliation(s)
- Ozgur Ozdemir
- Department of Neurosurgery, Baskent University Faculty of Medicine, Ankara, Turkey.
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Non-surgical management of intracranial subdural hematoma complicating spinal anesthesia. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70309-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Woitzik J, Barth M, Tuettenberg J. Persistent postpartum headache from a chronic subdural hematoma after peridural anesthesia. Obstet Gynecol 2006; 108:808-9. [PMID: 17018511 DOI: 10.1097/01.aog.0000214944.15388.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum headache after peridural anesthesia is usually attributed to accidental perforation of the dura causing postlumbar puncture headache. CASE In a patient with persistent headache after peridural anesthesia for labor, a chronic subdural hematoma was diagnosed 5 weeks postpartum. CONCLUSION Caution is warranted in patients with peridural anesthesia for labor who present with unusually persistent headache.
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Affiliation(s)
- Johannes Woitzik
- Department of Neurosurgery, University Hospital Mannheim, Faculty for Clinical Medicine of the University of Heidelberg, Mannheim, Germany.
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Narouze SN, Casanova J, El-Jaberi M, Farag E, Tetzlaff JE. Inadvertent dural puncture during attempted thoracic epidural catheter placement complicated by cerebral and spinal subdural hematoma. J Clin Anesth 2006; 18:132-4. [PMID: 16563332 DOI: 10.1016/j.jclinane.2005.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 05/16/2005] [Indexed: 11/19/2022]
Abstract
Minor complications of inadvertent dural puncture during attempted epidural anesthesia are common, related to the size of the needle and the incidence of postdural puncture headache. Serious complications are much less common. We report a case where inadvertent dural puncture with an 18-gauge epidural needle was associated with the creation of intracranial and spinal subdural hematoma.
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Affiliation(s)
- Samer N Narouze
- Department of Anesthesiology, Aultman Health Foundation, Canton, OH, USA
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Zeidan A, Farhat O, Maaliki H, Baraka A. Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature. Int J Obstet Anesth 2006; 15:50-8. [PMID: 16256333 DOI: 10.1016/j.ijoa.2005.07.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 04/01/2005] [Accepted: 06/01/2005] [Indexed: 11/20/2022]
Abstract
The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.
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Affiliation(s)
- A Zeidan
- Department of Anesthesiology, Sahel General Hospital, Beirut, Lebanon
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Diaz JH, Weed JT. Correlation of Adverse Neurological Outcomes with Increasing Volumes and Delayed Administration of Autologous Epidural Blood Patches for Postdural Puncture Headaches. Pain Pract 2005; 5:216-22. [PMID: 17147583 DOI: 10.1111/j.1533-2500.2005.05305.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Epidural blood patches (EBPs) usually afford rapid and successful treatment outcomes for postdural puncture headaches (PDPH) with few adverse sequelae. PATIENTS AND METHODS In order to identify potential risk factors for any adverse outcomes of EBP, a Medline search, 1966 to the present, of case reports and series of any adverse outcomes following EBP for PDPH was conducted. The literature search identified 26 patient cases with 21 cases defined as adverse neurological outcomes, and further stratified as compression or noncompression syndromes, and five cases defined as persistent cranial nerve (CN) palsies. Cases were also stratified by age, sex, and blood volumes of EBP or delays in administration, and compared for statistically significant differences in continuous variables by unpaired, two-tailed t-tests and for significant correlations between predictor variables, including EBP volumes and delays in administration, and adverse neurological outcomes, by simple linear regression analysis. RESULTS There were no statistically significant sex differences in the mean ages or weights of the study population, or in the total volumes of autologous blood injected in EBPs. When the study population was compared for adverse neurological outcomes by compression or noncompression syndromes, patients experiencing compression syndromes received significantly more EBP volumes (35.36 mL) than patients experiencing noncompression (17.46 mL) syndromes (P = 0.025). Regression analysis confirmed a significant direct linear relationship between increasing EBP volumes and worsening adverse neurological outcomes (P = 0.008). In patients with CN palsies associated with PDPH and unrelieved by EBP, regression analysis again confirmed significant direct linear relationships between increasing days waited to perform EBP and increasing duration of CN palsies in months (P = 0.001). CONCLUSIONS Epidural blood patches for the management of PDPH, especially PDPH associated with CN palsies, should be administered as soon as the diagnosis of PDPH is made with lower volumes of autologous blood (< or =20 mL) to assure the best treatment outcomes.
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Affiliation(s)
- James H Diaz
- School of Medicine, Louisiana State University Health Sciences Center in New Orleans, Louisiana 70112, USA.
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Yildirim GB, Colakoglu S, Atakan TY, Büyükkirli H. Intracranial subdural hematoma after spinal anesthesia. Int J Obstet Anesth 2005; 14:159-62. [PMID: 15795150 DOI: 10.1016/j.ijoa.2004.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Revised: 06/01/2004] [Accepted: 08/13/2004] [Indexed: 11/25/2022]
Abstract
Intracranial subdural hematoma is an exceptionally rare but life-threatening complication of spinal anesthesia. We report a case of intracranial subdural hematoma following spinal anesthesia for cesarean section in a 27-year-old woman. She developed a diffuse headache after surgery with a blood pressure of 220/140 mm Hg which was followed by generalized seizure activity. Her blood pressure remained high after medication with diazepam, nifedipine and magnesium sulfate. She remained unconscious with a Glasgow coma scale of 5. The cranial tomography revealed a subdural hematoma with diffuse cerebral edema and cerebral tentorial herniation. When a patient complains of postdural puncture headache and then has seizure activity, one should consider alternative diagnoses, including that of a subdural hematoma, and carry out a careful examination, including magnetic resonance imaging or computerized tomography scan.
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Affiliation(s)
- G Berkel Yildirim
- Department of Anesthesiology and Intensive Care, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
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Castillo D, Tsen LC. Epidural blood patch placed in the presence of an unknown cervical epidural hematoma. Anesth Analg 2003; 97:885-887. [PMID: 12933422 DOI: 10.1213/01.ane.0000078579.75593.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We discuss a case detailing a favorable outcome of an epidural blood patch performed in the presence of an unknown cervical epidural hematoma. The case highlights the use of a spinal needle for epidural space confirmation, the importance of waiting for final consultation and radiologic testing results before therapeutic intervention when possible, and the use of an epidural blood patch, even in the setting of a known epidural hematoma.
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Affiliation(s)
- Daniel Castillo
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
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