Issı Zeynep, Öztürk Vesile, İyilikçi Leyla, Erkin Yüksel
Department of Neurology, Division of Algology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
Department of Neurology, Dokuz Eylül University School of Medicine, İzmir, Turkey.
Turk J Anaesthesiol Reanim. 2018 Aug;46(4):319-322. doi: 10.5152/TJAR.2018.28044. Epub 2018 Aug 1.
Haemorrhage in the neuraxial region following spinal and epidural interventions is a rare and unexpected complication. Subdural haemorrhage is the most frequently occurring type. A 64-year-old male patient was admitted with complaints of severe headache and intermittent fever after 14 days of spinal anaesthesia and inguinal hernia operation. Neurological examination and systemic examination showed no features other than that for postural tremor. Cranial and spinal magnetic resonance (MR) imaging were requested for the differential diagnosis of the patient with secondary headaches. In MR, subacute subdural haemorrhage adjacent to the dura, limiting the posterior sulcus, and extra axial distance (not clearly distinguishable epidural-subdural distinction) along the entire spinal canal were detected. The patient who had no neurological deficit and no culture recruitment underwent conservative treatment. We would like to emphasize here that the coexistence of both intracranial subdural and spinal subdural-epidural haemorrhage can be seen as a complication after spinal anaesthesia, which has not been previously observed in the literature, along with the importance of headache after regional anaesthesia.
脊柱和硬膜外干预后神经轴区域出血是一种罕见且意外的并发症。硬膜下出血是最常见的类型。一名64岁男性患者在脊髓麻醉和腹股沟疝手术后14天因严重头痛和间歇性发热入院。神经检查和全身检查除姿势性震颤外无其他异常。为鉴别该继发性头痛患者，进行了头颅和脊柱磁共振成像检查。磁共振成像显示，硬膜附近存在亚急性硬膜下出血，限制了后沟，并沿整个椎管出现了轴外间隙（硬膜外-硬膜下界限不清晰）。该患者无神经功能缺损且无培养物检出，接受了保守治疗。在此我们想强调，颅内硬膜下和脊柱硬膜下-硬膜外出血并存可视为脊髓麻醉后的一种并发症，这在以往文献中未曾观察到，同时也强调了区域麻醉后头痛的重要性。
