Tanabe Yuko, Fujinaka Waso, Takatori Makoto, Tada Keiichi
Department of Anesthesiology and Intensive Care, Hiroshima City Hospital, Hiroshima 730-8518.
Masui. 2013 Mar;62(3):315-7.
Intracranial subdural hematoma (SDH) occurred in a 58-year-old female after laparoscopy-assisted distal gastrectomy under general and thoracic epidural anesthesia. On postoperative day 2, she complained of headache in sitting position, but there were no remarkable neurological defect and nausea. On postoperative day 5, her headache subsided and she could walk by herself. But on postoperative day 10, she felt heavy-headed again, and complained sensory abnormality of her right leg. Magnetic resonance imaging of the head showed small acute subdural hematoma in bilateral parietal regions with no mass effect. She was managed conservatively with bed rest and intravenous fluids. Her condition improved and was discharged on postoperative day 17 without subsequent complications. SDH after epidural anesthesia is rare, but diagnosis in early stage has a decisive influence on its prognosis. It is crucial to exclude the possibility of SDH and observe closely if the patient complains of severe headache or another unexplained symptom only with postdural puncture headache.
一名58岁女性在全身麻醉和胸段硬膜外麻醉下行腹腔镜辅助远端胃切除术后发生颅内硬膜下血肿（SDH）。术后第2天，她主诉坐位时头痛，但无明显神经功能缺损及恶心症状。术后第5天，她的头痛缓解，能够自行行走。但术后第10天，她再次感到头部沉重，并主诉右腿感觉异常。头部磁共振成像显示双侧顶叶区域有小的急性硬膜下血肿，无占位效应。她接受了卧床休息和静脉补液的保守治疗。她的病情好转，术后第17天出院，无后续并发症。硬膜外麻醉后发生SDH很罕见，但早期诊断对其预后有决定性影响。如果患者仅在硬膜穿刺后头痛时主诉严重头痛或其他无法解释的症状，排除SDH的可能性并密切观察至关重要。
