Duarte Wallace Lage, Araújo Fabiano de Souza, Almeida Marcelo Figueiredo, Geber Débora Grimberg, de Castro Carlos Henrique Viana
Departamento de Anestesiologia do Hospital Lifecenter, Belo Horizonte, MG.
Rev Bras Anestesiol. 2008 Jul-Aug;58(4):387-90. doi: 10.1590/s0034-70942008000400008.
Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In those situations, imaging exams are extremely useful. The objective of this report was to present the case of a patient who developed subdural hematoma after accidental puncture of the dura mater during epidural block. CASE REPORT A 47-year old male patient, 147 kg, 1.90 m, physical status ASA II, was admitted for abdominal dermolipectomy after undergoing gastroplasty. The dura mater was accidentally punctured during the epidural block. The patient developed postdural puncture headache treated with an epidural blood patch, with partial improvement of his symptoms. However, it was followed by worsening of the headache and an MRI showed the presence of an intracranial subdural hematoma, which was treated clinically The patient evolved with progressive improvement of the symptom and full recovery after 30 days.
Subdural hematoma is a rare, but severe, complication of dura mater puncture. It is difficult to diagnose, but it should always be remembered when post-dural puncture headache shows no resolution or even worsens after an epidural blood patch. An imaging exam is fundamental for the diagnosis of this rare complication.
硬膜穿刺后头痛是硬膜外阻滞和蛛网膜下腔阻滞的一种常见并发症，血液填充是最常用的治疗方法。大多数患者经血液填充后头痛完全缓解，但仍有部分患者症状无改善或仅部分缓解。对于这些患者，应谨慎寻找其他鉴别诊断，如硬膜下血肿或气颅。在这些情况下，影像学检查极为有用。本报告旨在介绍1例硬膜外阻滞时意外穿破硬脊膜后发生硬膜下血肿的患者。病例报告 1例47岁男性患者，体重147kg，身高1.90m，ASAⅡ级身体状况，因胃成形术后行腹部皮肤切除术入院。硬膜外阻滞时意外穿破硬脊膜。患者发生硬膜穿刺后头痛，经硬膜外血液填充治疗，症状部分改善。然而，随后头痛加重，MRI显示颅内硬膜下血肿，遂进行临床治疗。患者症状逐渐改善，30天后完全康复。
硬膜下血肿是硬膜穿破的一种罕见但严重的并发症。其诊断困难，但当硬膜穿刺后头痛在硬膜外血液填充后无缓解甚至加重时，应始终考虑到该并发症。影像学检查对于诊断这种罕见并发症至关重要。
