Skip to main content

photo of the month...Post dural puncture Subdural hematoma



Subdural intracranial hematoma is a very rare consequence of accidental dural puncture. 

 The bleeding results from cerebrospinal fluid loss (cerebral hypotension) related to traction on the intracranial bridging veins.

Postdural puncture headache may complicate the diagnosis. 

 Atypical headache (absence of postural component, persistence for more than 7 days, unresponsiveness to analgesics), signs of increased intracranial pressure, or mass effect on brain parenchyma (vomiting, seizures, altered level of consciousness,focal motor and sensory deficits) should lead to consideration of subdural intracranial hematoma.
Presence of semilunar extraparenchymal liquid over the convexity on computed tomography (more sensitive in acute situations) or magnetic resonance imaging (more sensitive in older “denser” hematomas) scans confirms the diagnosis (arrows).
In view of the small size of the hematomas, in our case conservative management was deemed appropriate. However, when there is mass effect, compression, and midline shift, surgical evacuation of the hematoma is the treatment of choice.

  Epidural blood patch (treatment of postdural puncture headache) when performed in the presence of intracranial hemorrhage may lead to rebound intracranial hypertension and neurologic deterioration. 

 Ourpatient was discharged homewithout any neurologic sequelae.A follow-up magnetic resonance imaging
showed spontaneous resolution. 

 Subdural intracranial hematoma should be considered in the differential diagnosis of postpartum headache.


1. 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

2. Ezri T, Abouleish E, Lee C, Evron S: Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome. Can J Anaesth 2002; 49:820 –3

3. Kayacan N, Arici G, Karsli B, Erman M: Acute subdural haematoma after accidental dural puncture during epidural anaesthesia. Int J Obstet Anesth 2004; 13:47–9





Labels

Labels:

Comments

Post a Comment

Popular posts from this blog

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...
5 comments
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more

Epidural catheter tests...not only the test dose

Siphon test The catheter is held upright and a fluid level sought. If the catheter is then elevated, the fluid level should fall (see inset) as the fluid siphons in to the epidural space, which is usually under negative pressure compared with atmospheric. If the fluid column continues to rise, this may suggest subarachnoid placement. The siphon test can be reassuring, but is not mandatory. Aspiration  This should be considered mandatory. The Luer connector is attached to the catheter and a syringe is used to apply negative pressure. Free and continued aspiration of clear fluid can indicate subarachnoid placement of the catheter. However, if saline has been used for loss of resistance, it is not unusual for a small amount of this to be aspirated. If there is doubt, the aspirated fluid can be tested for glucose (cerebrospinal fluid will generally test positive) or mixed with thiopentone (cerebrospinal fluid forms a precipitate). If blood is freely and continuously aspirated, this sug...
Post a Comment
Read more