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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.
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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
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Zekaj E, Saleh C, Minichiello M, Perazzo P, Servello D. How to Treat Repeated Subdural Hematomas after Lumbar Puncture? Asian J Neurosurg 2019; 14:249-252. [PMID: 30937046 PMCID: PMC6417290 DOI: 10.4103/ajns.ajns_263_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Serious complications following spinal anesthesia (SA) are rare. However, surgeons and neurologist need to be aware that postsurgery headache refractory to conservative treatment or change in headache's characteristics could be due to serious intracranial complications such as a subdural hematoma. Any delay in diagnosis and treatment can be fatal. We report and discuss a case of a patient who suffered repeated subdural bleeds following SA.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy
| | - Christian Saleh
- Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy
| | - Marina Minichiello
- Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy
| | - Paolo Perazzo
- Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy
| | - Domenico Servello
- Department of Neurosurgery and Neurology, IRCCS Galeazzi Hospital, 20161 Milan, Italy
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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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Schweiger V, Zanconato G, Lonati G, Baggio S, Gottin L, Polati E. Intracranial subdural hematoma after spinal anesthesia for cesarean section. Case Rep Obstet Gynecol 2013; 2013:253408. [PMID: 24455348 PMCID: PMC3884612 DOI: 10.1155/2013/253408] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022] Open
Abstract
Intracranial subdural hematoma following spinal anesthesia is an infrequent occurrence in the obstetric population. Nevertheless, it is a potentially life-threatening complication. In the majority of the cases, the first clinical symptom associated with intracranial subdural bleeding is severe headache, but the clinical course may have different presentations. In this report, we describe the case of a 38-year-old woman with an acute intracranial subdural hematoma shortly after spinal anesthesia for cesarean section. Early recognition of symptoms of neurologic impairment led to an emergency craniotomy for hematoma evacuation with good recovery of neurologic functions. The possibility of subdural hematoma should be considered in any patient complaining of severe persistent headache following regional anesthesia, unrelieved by conservative measures. Only early diagnosis and an appropriate treatment may avoid death or irreversible neurologic damage.
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Affiliation(s)
- Vittorio Schweiger
- Department of Anesthesiological Sciences and Specialistic Surgeries, University of Verona, 37134 Verona, Italy
| | - Giovanni Zanconato
- Department of Life Science and Reproduction, University of Verona, 37134 Verona, Italy
- U.O. di Ginecologia e Ostetricia, Policlinico Borgo Roma, 37134 Verona, Italy
| | - Gisella Lonati
- Department of Anesthesiological Sciences and Specialistic Surgeries, University of Verona, 37134 Verona, Italy
| | - Silvia Baggio
- Department of Life Science and Reproduction, University of Verona, 37134 Verona, Italy
| | - Leonardo Gottin
- Department of Anesthesiological Sciences and Specialistic Surgeries, University of Verona, 37134 Verona, Italy
| | - Enrico Polati
- Department of Anesthesiological Sciences and Specialistic Surgeries, University of Verona, 37134 Verona, Italy
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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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Amorim JA, Remígio DSCDA, Damázio Filho O, de Barros MAG, Carvalho VN, Valença MM. Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature. Rev Bras Anestesiol 2011; 60:620-9, 344-9. [PMID: 21146058 DOI: 10.1016/s0034-7094(10)70077-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 06/04/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other 33 cases found on literature review. CASE REPORTS In 35 patients (ages 20-88 years, 19 males), 14 were older than 60 years (40%), of which 12 (86%) were males. The relationship is inverted in the group of younger patients (< 60 years), in which we observed twice as many women (14:7). Two peaks of higher incidence were observed: 30-39 years (31%) and 60-69 years (29%). The length of time from the beginning of symptoms until diagnosis ranged from 4 hours to 29 weeks. Headache was the main complaint in 26/35 (74.3%) patients; changes in the level of consciousness in 14/35 (40.0%); vomiting in 11/35 (31,4%); hemiplegia or hemiparesis in 8/35 (22.9%); diplopia or VI nerve paresis in 5/35 (14.3%); and language disorders in 4/35 (11.4%). Contributing factors included: pregnancy, multiple punctures, use of anticoagulants, intracranial vascular abnormalities, and brain atrophy. In 15 cases, a contributing factor was not mentioned. Four out of 35 patients (11.4%) remained with neurologic sequelae, and 4/35 (11.4%) died. CONCLUSIONS The presence of any of the signs or symptoms mentioned above should alert for the possibility of an intracranial subdural hematoma as a complication of puncture of the dura mater, especially in those patients with PDPH for more than one week, at which time investigation by neuroimaging is necessary.
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Affiliation(s)
- Jane Auxiliadora Amorim
- Centro de Ensino e Treinamento em Anestesiologia of Hospitais da Restauração (HR), Getúlio Vargas (HGV), e Oswaldo Cruz (HOC), Recife-PE, Brazil.
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