Fujii Mutsumi, Arai Toshinari, Matsuoka Yoshiyuki, Karakama Jun, Morimoto Takashi, Ohno Kikuo
Department of Neurosurgery, Soka Municipal Hospital.
No Shinkei Geka. 2010 Jun;38(6):563-8.
Chronic subdural hematoma is a rare complication of epidural anesthesia. This report describes the case of a 34-year-old woman who presented with postpartum headache after she received epidural anesthesia for labor pain. The anesthesiologist's record did not show any anesthesia-related complication. Two days after the delivery (on day 2), the patient complained of headache. Postdural puncture headache was diagnosed, so she was administered analgesics, hydration therapy, and bed rest. On day 4, she reported a slight improvement and was discharged. The postural headache persisted even on day 7 after delivery. During the conservative treatment, she had suffered a mild head trauma. On day 13, she started to feel a non-postural and severe throbbing headache. On day 24, she was referred to our department. Bilateral chronic subdural hematoma was confirmed by a computed tomography scan. Physical examination revealed only mild right hemiparesis. Left burr hole trepanation was performed and this was followed by uneventful postoperative course. Right chronic subdural hematoma was managed by conservative treatment, and it completely recovered after 4 weeks. Chronic subdural hematoma should be considered when postpartum patients who have received epidural anesthesia present with mild to severe, persistent, and non-postural headache.
慢性硬膜下血肿是硬膜外麻醉的一种罕见并发症。本报告描述了一名34岁女性的病例,她在接受硬膜外分娩镇痛后出现产后头痛。麻醉医生的记录未显示任何与麻醉相关的并发症。分娩后两天(第2天),患者主诉头痛。诊断为硬膜穿刺后头痛,因此给予她镇痛药、补液治疗和卧床休息。第4天,她报告症状稍有改善并出院。产后第7天,她的体位性头痛仍持续存在。在保守治疗期间,她遭受了轻度头部外伤。第13天,她开始感到非体位性的严重搏动性头痛。第24天,她被转诊至我科。计算机断层扫描证实为双侧慢性硬膜下血肿。体格检查仅发现轻度右侧偏瘫。实施了左侧钻孔开颅术,术后过程顺利。右侧慢性硬膜下血肿采用保守治疗,4周后完全恢复。对于接受硬膜外麻醉的产后患者出现轻至重度、持续性和非体位性头痛时,应考虑慢性硬膜下血肿。