Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports
Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complicati...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Wendy Chou [verfasserIn] Saamia Alam [verfasserIn] Lucas Bracero [verfasserIn] Joy Schabel [verfasserIn] Sergio Bergese [verfasserIn] Ana Costa [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2023 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
In: Bulletin of the National Research Centre - SpringerOpen, 2018, 47(2023), 1, Seite 6 |
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| Übergeordnetes Werk: |
volume:47 ; year:2023 ; number:1 ; pages:6 |
| Links: |
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| DOI / URN: |
10.1186/s42269-023-01014-z |
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| Katalog-ID: |
DOAJ087777096 |
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| 520 | |a Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. | ||
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10.1186/s42269-023-01014-z doi (DE-627)DOAJ087777096 (DE-599)DOAJa50b786315f247cb93c2b66462388853 DE-627 ger DE-627 rakwb eng Wendy Chou verfasserin aut Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. Post-dural puncture headache Epidural blood patch Subdural hematoma Dural puncture epidural Case series Science Q Saamia Alam verfasserin aut Lucas Bracero verfasserin aut Joy Schabel verfasserin aut Sergio Bergese verfasserin aut Ana Costa verfasserin aut In Bulletin of the National Research Centre SpringerOpen, 2018 47(2023), 1, Seite 6 (DE-627)1035877007 25228307 nnns volume:47 year:2023 number:1 pages:6 https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/article/a50b786315f247cb93c2b66462388853 kostenfrei https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/toc/2522-8307 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 6 |
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10.1186/s42269-023-01014-z doi (DE-627)DOAJ087777096 (DE-599)DOAJa50b786315f247cb93c2b66462388853 DE-627 ger DE-627 rakwb eng Wendy Chou verfasserin aut Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. Post-dural puncture headache Epidural blood patch Subdural hematoma Dural puncture epidural Case series Science Q Saamia Alam verfasserin aut Lucas Bracero verfasserin aut Joy Schabel verfasserin aut Sergio Bergese verfasserin aut Ana Costa verfasserin aut In Bulletin of the National Research Centre SpringerOpen, 2018 47(2023), 1, Seite 6 (DE-627)1035877007 25228307 nnns volume:47 year:2023 number:1 pages:6 https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/article/a50b786315f247cb93c2b66462388853 kostenfrei https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/toc/2522-8307 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 6 |
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10.1186/s42269-023-01014-z doi (DE-627)DOAJ087777096 (DE-599)DOAJa50b786315f247cb93c2b66462388853 DE-627 ger DE-627 rakwb eng Wendy Chou verfasserin aut Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. Post-dural puncture headache Epidural blood patch Subdural hematoma Dural puncture epidural Case series Science Q Saamia Alam verfasserin aut Lucas Bracero verfasserin aut Joy Schabel verfasserin aut Sergio Bergese verfasserin aut Ana Costa verfasserin aut In Bulletin of the National Research Centre SpringerOpen, 2018 47(2023), 1, Seite 6 (DE-627)1035877007 25228307 nnns volume:47 year:2023 number:1 pages:6 https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/article/a50b786315f247cb93c2b66462388853 kostenfrei https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/toc/2522-8307 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 6 |
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10.1186/s42269-023-01014-z doi (DE-627)DOAJ087777096 (DE-599)DOAJa50b786315f247cb93c2b66462388853 DE-627 ger DE-627 rakwb eng Wendy Chou verfasserin aut Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. Post-dural puncture headache Epidural blood patch Subdural hematoma Dural puncture epidural Case series Science Q Saamia Alam verfasserin aut Lucas Bracero verfasserin aut Joy Schabel verfasserin aut Sergio Bergese verfasserin aut Ana Costa verfasserin aut In Bulletin of the National Research Centre SpringerOpen, 2018 47(2023), 1, Seite 6 (DE-627)1035877007 25228307 nnns volume:47 year:2023 number:1 pages:6 https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/article/a50b786315f247cb93c2b66462388853 kostenfrei https://doi.org/10.1186/s42269-023-01014-z kostenfrei https://doaj.org/toc/2522-8307 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 6 |
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Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. 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Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports |
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Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. |
| abstractGer |
Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. |
| abstract_unstemmed |
Abstract Background Neuraxial anesthesia is widely used for labor analgesia in the USA, such as epidural, combined spinal–epidural, and dural puncture epidural (DPE). Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. Case two: A 31-year-old G1P0 female at 41-week gestation with a past medical history of a chronic right parietal hemangioma and malaria at 29-week gestation received a DPE for induction of labor. She subsequently underwent a primary cesarean section for failure to progress and persistent category-two fetal heart rate tracing. On postoperative day 11, she experienced a severe non-positional right-sided headache. Imaging revealed a subdural hematoma overlying the right frontal temporal and parietal lobes, which was observed and managed non-operatively. On postoperative day 14, the patient received an epidural blood patch for symptomatic intracranial hypotension. Conclusion PDPH, a complication of neuraxial anesthesia, is typically benign and often self-resolves with conservative measures. However, to avoid increased morbidity and mortality, monitoring in patients with PDPH at a higher risk for development of subdural hematomas (especially those with known preexisting intracranial pathologies) is critical for prompt diagnosis. As exemplified by our second case, epidural blood patches continue to be effective and may be considered in patients with symptomatic intracranial hypotension. |
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Subdural hematoma following dural puncture epidural anesthesia for labor analgesia: two case reports |
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https://doi.org/10.1186/s42269-023-01014-z https://doaj.org/article/a50b786315f247cb93c2b66462388853 https://doaj.org/toc/2522-8307 |
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Saamia Alam Lucas Bracero Joy Schabel Sergio Bergese Ana Costa |
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Post-dural puncture headache (PDPH) is a well-known complication of neuraxial anesthesia. However, a rare yet more serious complication is subdural hematomas. Untreated subdural hematomas can result in permanent disability and death, hence the need to better understand their development in the obstetric population receiving DPE. Case presentation Case one: A 34-year-old G6P3 female at 39-week gestation received a DPE for labor analgesia and underwent a cesarean section for arrest of descent. On postoperative day two, the patient developed a PDPH but opted for conservative treatment. Ten days post-discharge, the patient presented with a large subacute to chronic subdural hematoma with midline shift. The patient underwent a right fronto-temporal craniectomy, evacuation of subdural hematoma, and placement of a subdural drain. 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