Anesthesia and Intensive Care Unit I, A.O.U. Policlinico Consorziale, Bari, Italy.
Minerva Anestesiol. 2010 Dec;76(12):1091-4.
Intracranial subdural hematoma is a rare, but well-described complication of epidural and spinal anesthesia, as documented by more than a decade of publications. Non-postural headache and vomiting are warning signs. A headache lasting more than 5 days should arouse suspicion of intracranial hemorrhage, whether or not it is associated with the appearance of neurological signs or the deterioration of neurological status. Urgent cranial computed tomography can confirm the diagnosis of subdural hematoma, which has the potential to cause a dramatic cerebral herniation syndrome. A combination of spinal epidural (CSE) anesthesia and analgesia is commonly used to obtain pain relief during caesarean sections and labor. We report the case of a patient who suffered from severe neurological deterioration and manifested signs of brain herniation due to the development of an acute intracranial subdural hematoma after CSE analgesia for labor. An emergency craniotomy was performed to remove the subdural hematoma and the patient recovered well. Close observation of patients undergoing CSE analgesia or anesthesia complaining of prolonged non-postural headaches, with or without neurological symptoms, is recommended.
颅内硬膜下血肿是硬膜外和脊髓麻醉的罕见但已有充分描述的并发症，已有十多年的出版物对此进行了记载。非体位性头痛和呕吐是警告信号。头痛持续超过 5 天应怀疑颅内出血，无论是否伴有神经体征的出现或神经状态的恶化。紧急颅计算机断层扫描可确诊硬膜下血肿，该病有引起显著脑疝综合征的风险。椎管内-硬膜外联合（CSE）麻醉和镇痛常用于剖宫产和分娩时缓解疼痛。我们报告了一例患者的病例，该患者在 CSE 镇痛分娩后发生急性颅内硬膜下血肿，导致严重神经恶化并表现出脑疝迹象。紧急开颅手术以去除硬膜下血肿，患者恢复良好。建议对接受 CSE 镇痛或麻醉的患者进行密切观察，这些患者主诉持续性非体位性头痛，无论是否伴有神经症状。
