Zeidan A, Farhat O, Maaliki H, Baraka A
Department of Anesthesiology, Sahel General Hospital, Lebanon.
Middle East J Anaesthesiol. 2010 Feb;20(4):483-92.
The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.
该患者为一名39岁的孕妇，计划进行剖宫产。使用带有无创伤斜面的26号针进行脊髓麻醉。术后，患者出现颅内硬膜下血肿，表现为严重的非体位性头痛，伴有右眼流泪、第五颅神经麻痹和左侧偏瘫。计算机断层扫描确诊了该诊断。患者通过与保守治疗相关的仔细神经学随访进行管理，并在12周后完全康复。我们的报告回顾了46例在脊髓或硬膜外麻醉后发生硬膜穿刺后头痛并发硬膜下血肿患者的文献。未经治疗的硬膜穿刺后头痛可能会并发硬膜下血肿。对于保守措施无法缓解的硬膜穿刺后头痛患者，以及从体位性头痛转变为非体位性头痛的患者，需要进行仔细随访，以便早期诊断和处理可能的硬膜下血肿。
