López-Soriano F, Amorín M, Lajarín B, Rivas F
Servicio de Anestesiología y Reanimación, Hospital del Noroeste de Murcia, Caravaca de la Cruz, Murcia.
Rev Esp Anestesiol Reanim. 2006 Feb;53(2):110-3.
Cerebellar hemorrhage is a rare complication of spinal anesthesia. We report a case in a 51-year-old woman with a history of hypertension who underwent uterine dilatation and curettage with spinal anesthesia. During recovery she vomited and complained of headache. Postdural puncture headache was diagnosed. When there was no response to conventional treatment, computed tomography and magnetic resonance scans of the head were performed. The scans confirmed cerebellar hemorrhage due to rupture of a cavernous angioma. The patient recovered fully without surgical decompression. We review the pathogenesis of headache and cerebral hemorrhage after spinal anesthesia and propose differential diagnosis between spontaneous rupture related to hypertension and cerebrospinal fluid hypotension syndrome caused by trauma from lumbar spinal puncture. Patients with prolonged severe headache after spinal anesthesia require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.
小脑出血是脊髓麻醉的一种罕见并发症。我们报告一例51岁有高血压病史的女性,她在脊髓麻醉下接受了子宫扩张刮宫术。恢复过程中她呕吐并诉说头痛。诊断为硬膜穿刺后头痛。常规治疗无效后,对其头部进行了计算机断层扫描和磁共振扫描。扫描证实为海绵状血管瘤破裂导致的小脑出血。患者未经手术减压完全康复。我们回顾了脊髓麻醉后头痛和脑出血的发病机制,并提出了高血压相关的自发性破裂与腰椎穿刺创伤引起的脑脊液低压综合征之间的鉴别诊断。脊髓麻醉后出现长时间严重头痛的患者需要进行神经学和影像学监测,以排除颅内并发症的可能性。