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剖宫产术后脊髓麻醉后慢性颅内硬膜下血肿:病例报告。

Chronic intracranial subdural hematoma after spinal anesthesia for a cesarean section: a case report.

机构信息

Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 143079, Addis Ababa, Ethiopia.

Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, P.O.Box 1271, Addis Ababa, Ethiopia.

出版信息

J Med Case Rep. 2021 Oct 7;15(1):492. doi: 10.1186/s13256-021-03100-0.

DOI:10.1186/s13256-021-03100-0
PMID:34615533
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8496000/
Abstract

BACKGROUND

Subdural hematoma is a rare, potentially devastating, yet curable complication of spinal anesthesia. Differentiation between post-dural puncture headache and subdural hematoma can be difficult, resulting in a delay in diagnosis.

CASE PRESENTATION

We present a 28-year-old Ethiopian female patient who underwent elective cesarean section under spinal anesthesia and returned to the emergency department after 1 month with a worsening headache. Brain computed tomography revealed a chronic subdural hematoma with a significant midline shift. The patient recovered completely after surgical evacuation.

CONCLUSIONS

A high index of suspicion and close attention to the pattern and characteristics of the headache, coupled with a meticulous neurologic examination and neuroimaging, can help to achieve timely diagnosis of this serious entity. Investigation with head computed tomography or magnetic resonance imaging is vital.

摘要

背景

硬脊膜外血肿是一种罕见但具有潜在破坏性、可治愈的脊髓麻醉并发症。硬膜穿破后头痛和硬脊膜外血肿的鉴别可能较为困难,导致诊断延迟。

病例介绍

我们报告了一位 28 岁的埃塞俄比亚女性患者,她在脊髓麻醉下接受了择期剖宫产,并在 1 个月后因头痛加剧返回急诊。脑计算机断层扫描显示慢性硬脊膜外血肿伴明显中线移位。患者经手术清除后完全康复。

结论

高度怀疑并密切关注头痛的模式和特征,结合细致的神经系统检查和神经影像学检查,有助于及时诊断这种严重疾病。头部计算机断层扫描或磁共振成像检查至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7b7/8496000/6c04b833cec8/13256_2021_3100_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7b7/8496000/6c04b833cec8/13256_2021_3100_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7b7/8496000/6c04b833cec8/13256_2021_3100_Fig1_HTML.jpg

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本文引用的文献

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Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review.硬膜外血贴治疗自发性颅内低压合并慢性硬膜下血肿:一例报告及文献复习
J Int Med Res. 2016 Aug;44(4):976-81. doi: 10.1177/0300060516645955. Epub 2016 May 25.
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Postdural puncture subdural hematoma or postdural puncture headache?: two cases report.硬膜穿刺后硬脑膜下血肿还是硬膜穿刺后头痛?两例报告
Korean J Anesthesiol. 2015 Oct;68(5):509-12. doi: 10.4097/kjae.2015.68.5.509. Epub 2015 Sep 30.
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Thoracic epidural blood patch for spontaneous intracranial hypotension: case report and review of the literature.
胸椎硬膜外血贴治疗自发性颅内低压:病例报告及文献综述
Turk Neurosurg. 2015;25(2):320-5. doi: 10.5137/1019-5149.JTN.8096-13.1.
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Post-dural puncture headache.硬膜穿刺后头痛
Anesth Pain Med. 2012 Spring;1(4):273-4. doi: 10.5812/aapm.3610. Epub 2012 Apr 1.
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Why don't all individuals who undergo dura mater/arachnoid puncture develop postdural puncture headache?为什么并非所有接受硬脑膜/蛛网膜穿刺的个体都会发生硬膜穿刺后头痛?
Anesth Pain Med. 2012 Winter;1(3):207-9. doi: 10.5812/kowsar.22287523.3616. Epub 2012 Jan 1.
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Intracranial subdural hematoma after spinal anesthesia for cesarean section.剖宫产脊髓麻醉后颅内硬膜下血肿
Case Rep Obstet Gynecol. 2013;2013:253408. doi: 10.1155/2013/253408. Epub 2013 Dec 24.
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Pregnancy outcome using general anesthesia versus spinal anesthesia for in vitro fertilization.体外受精采用全身麻醉与脊髓麻醉的妊娠结局
Anesth Pain Med. 2013 Sep;3(2):239-42. doi: 10.5812/aapm.11223. Epub 2013 Sep 1.
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Intracranial subdural hematoma following spinal anesthesia: case report and review of the literature.脊髓麻醉后颅内硬膜下血肿:病例报告及文献综述
Acta Anaesthesiol Belg. 2010;61(2):63-6.
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Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature.脊髓麻醉后颅内硬膜下血肿:2例报告及文献中33例病例回顾
Rev Bras Anestesiol. 2010 Nov-Dec;60(6):620-9, 344-9. doi: 10.1016/S0034-7094(10)70077-5.
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[Intracranial subdural hematoma following dural puncture].硬膜穿刺后颅内硬膜下血肿
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