Domoto Syuhei, Suzuki Manzo, Suzuki Shinpei, Bito Hiroyasu
Department of Anesthesiology, Musashikosugi Hospital, Nippon Medical School, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
JA Clin Rep. 2018;4(1):18. doi: 10.1186/s40981-018-0151-8. Epub 2018 Feb 20.
Subdural hematoma (SDH) after accidental dural puncture (ADP) is rare but may be lethal. We experienced a patient who developed SDH after combined spinal and epidural anesthesia without a headache.
A 41-year-old parturient female with an unruptured cerebral aneurysm, was scheduled to undergo elective cesarean delivery. Cerebrospinal fluid leakage was identified during puncture of the epidural space, and a catheter was placed after re-puncture. The postoperative course was normal except for incisional pain. The patient complained of slight neck stiffness on the second postoperative day. Magnetic resonance imaging (MRI) was performed to ensure that there was no intracranial problem on the fourth postoperative day and showed a bilateral subdural hematoma. Increase in size of hematoma was shown on computed tomography (CT) on the ninth postoperative day. Epidural blood patch was performed. A decrease in the size of the hematoma was confirmed on the CT images on the 11th postoperative day, and the patient was discharged. The patient has not developed any additional symptoms.
We experienced a patient who developed a SDH without a remarkable headache. It may be better to perform brain imaging studies, even if the patient does not complain of headache.
意外硬膜穿破（ADP）后发生硬膜下血肿（SDH）虽罕见但可能致命。我们遇到一名患者，在腰麻联合硬膜外麻醉后发生了SDH，且无头痛症状。
一名41岁未破裂脑动脉瘤的产妇，计划行择期剖宫产。硬膜外穿刺时发现脑脊液漏，重新穿刺后置入导管。术后除切口疼痛外，病程正常。患者术后第二天诉轻微颈部僵硬。术后第四天进行磁共振成像（MRI）以确保无颅内问题，结果显示双侧硬膜下血肿。术后第九天计算机断层扫描（CT）显示血肿增大。进行了硬膜外血贴治疗。术后第11天CT图像证实血肿缩小，患者出院。患者未出现任何其他症状。
我们遇到一名发生SDH且无明显头痛的患者。即使患者未诉头痛，进行脑部影像学检查可能更好。
