Ezri Tiberiu, Abouleish Ezzat, Lee Charles, Evron Shmuel
Department of Anesthesiology, Wolfson Medical Center, Holon, Israel.
Can J Anaesth. 2002 Oct;49(8):820-3. doi: 10.1007/BF03017415.
To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour.
This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000 x microL-1) who subsequently developed the syndrome of hemolysis, elevated liver enzymes and low platelets. On the first postoperative day, postdural puncture headache (PDPH) developed. An epidural blood patch (EBP) was deferred to the third postoperative day because of a platelet count of 21,000 x micro L-1. However, the headache intensified from a typical PDPH to one which was not posturally related. A second EBP was abandoned after the injection of 5 mL of blood because of increasing headache during the procedure. Magnetic resonance imaging revealed bilateral temporal subdural hematomas. The patient was managed conservatively and discharged home without any sequelae.
It is conceivable that thrombocytopenia together with possible abnormal platelet function increased the risk of subdural hematoma. Alternative diagnoses to PDPH should be considered whenever headache is not posturally related.
介绍一例在分娩时尝试硬膜外镇痛过程中硬膜穿刺后发生的产后双侧颅内硬膜下血肿病例。
该并发症发生在一名血小板减少（99,000/微升）的产妇意外硬膜穿刺后，该产妇随后出现了溶血、肝酶升高和血小板减少综合征。术后第一天，出现了硬膜穿刺后头痛（PDPH）。由于血小板计数为21,000/微升，硬膜外血贴（EBP）推迟到术后第三天进行。然而，头痛从典型的PDPH加重为与体位无关的头痛。在注入5毫升血液后，由于操作过程中头痛加剧，第二次EBP被放弃。磁共振成像显示双侧颞部硬膜下血肿。患者接受保守治疗，出院时无任何后遗症。
可以想象，血小板减少以及可能的血小板功能异常增加了硬膜下血肿的风险。每当头痛与体位无关时，应考虑PDPH的替代诊断。
