Division of Obstetrics and Gynecology, Department of Specific Organ Regulation, Osaka University Graduate School of Medicine, Osaka, Japan.
Int J Obstet Anesth. 2010 Jan;19(1):87-91. doi: 10.1016/j.ijoa.2009.05.007. Epub 2009 Nov 27.
A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, on the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obstetric regional anesthesia is exceedingly small even in a patient with coagulopathy and, to our knowledge, this is only the second reported case following obstetric regional anesthesia. Anesthesia for HELLP syndrome in patients with an adequate platelet count but without disseminated intravascular coagulation is controversial. It is therefore important for clinicians to recognize the symptoms and signs of spinal subarachnoid hematoma to avoid delay in treatment that might result in severe neurological deficit.
现报道一例 HELLP 综合征患者行剖宫产术脊麻后发生蛛网膜下腔血肿。一位 39 岁女性因重度子痫前期伴 HELLP 综合征行剖宫产术，行脊麻。尽管脊麻完全恢复，但术后第二天，她感到右腿后侧麻木，感觉不到膀胱充盈，出现轻度弛缓性截瘫。磁共振成像显示存在脊髓蛛网膜下腔血肿并伴有马尾神经受压。经保守治疗，她在三个月内几乎完全恢复。连续磁共振成像显示血肿自发消退。即使在凝血功能障碍的患者中，产科区域麻醉后发生脊髓蛛网膜下腔血肿的风险也非常小，据我们所知，这是产科区域麻醉后报告的第二例病例。对于血小板计数正常但无弥散性血管内凝血的 HELLP 综合征患者行麻醉存在争议。因此，临床医生识别脊髓蛛网膜下腔血肿的症状和体征非常重要，以避免因治疗延迟而导致严重的神经功能缺损。
