Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, OLV van Lourdes Ziekenhuis, Waregem, Belgium.
Department of Anesthesiology, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.
Pain Pract. 2021 Jan;21(1):83-87. doi: 10.1111/papr.12937. Epub 2020 Aug 10.
Cervical epidural corticosteroid injections are frequently used for the treatment of subacute cervicobrachial pain. This therapy is considered safe, with the vast majority of the complications being minor and transient.
We present a case of a woman in her fifties who suffered from cervicobrachialgia and received 2 cervical epidural corticosteroid infiltrations. On day 3 after the second infiltration, a new headache appeared and on day 16 a bilateral subdural hematoma was visualized on CT scan. Complete resorption of the hematoma was seen on day 25 without surgical intervention.
Up until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published. But several cases of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have been reported. Physicians should be aware of this potentially dramatic complication since post-dural puncture headache after any type of procedure can evolve into a subdural hematoma. Clinical differentiation between the two can be difficult; post-dural puncture headache is characterized by relief of symptoms in the supine position and photophobia/phonophobia. A subdural hematoma should be considered if the headache changes in character, does not respond to treatment, or there are neurological signs such as nausea/vomiting and blurred vision. Immediate medical imaging should then be performed.
颈椎硬膜外皮质类固醇注射常用于治疗亚急性颈臂痛。这种治疗被认为是安全的，绝大多数并发症是轻微和短暂的。
我们报告了一位五十多岁的女性病例，她患有颈臂痛并接受了 2 次颈椎硬膜外皮质类固醇浸润。第二次浸润后第 3 天出现新的头痛，第 16 天 CT 扫描显示双侧硬脑膜下血肿。血肿在第 25 天完全吸收，无需手术干预。
到目前为止，只有 1 例颈椎硬膜外类固醇注射后颅内硬脑膜下血肿的病例报告。但已有几例脊髓、硬膜外或联合脊髓和硬膜外麻醉后颅内硬脑膜下血肿的报告。医生应该意识到这种潜在的严重并发症，因为任何类型的操作后出现的穿硬脑膜后头痛都可能发展成硬脑膜下血肿。两者的临床鉴别可能很困难；穿硬脑膜后头痛的特征是在仰卧位时症状缓解，畏光/恐声。如果头痛性质改变、对治疗无反应或出现恶心/呕吐和视力模糊等神经症状，应考虑硬脑膜下血肿。然后应立即进行医学成像。
