Tondt Julie M, Counselman Francis L, Bono Michael J
Penn State Health Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania.
Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia.
Clin Pract Cases Emerg Med. 2023 Feb;7(1):39-42. doi: 10.5811/cpcem.2023.1.59331.
An acute subdural hematoma is a collection of blood in the space between the dural and arachnoid membranes overlying the brain. Head trauma is the most common cause. Less frequently, low cerebrospinal fluid pressure, due to a spontaneous or iatrogenic cerebrospinal fluid leak can result in a subdural hematoma.
We discuss the case of a 26-year-old woman who presented with a frontal headache following epidural anesthesia for vaginal delivery. The differential diagnosis included spinal headache, postpartum hypercoagulability, dural sinus thrombosis, and intracranial hemorrhage or mass. Her vital signs and physical examination were normal. A computed tomography of the brain revealed an acute subdural hematoma along the left frontal cerebral hemisphere, without midline shift or mass effect. A blood patch was placed with complete resolution of her symptoms.
This case illustrates an unusual case of an acute subdural hematoma in the postpartum period following epidural anesthesia for labor pain management. It was thought to be caused by intracranial hypotension following epidural anesthesia and a cerebrospinal fluid leak.
急性硬膜下血肿是指位于覆盖大脑的硬脑膜和蛛网膜之间间隙内的血液聚集。头部外伤是最常见的原因。较少见的情况下，自发性或医源性脑脊液漏导致的低脑脊液压力可引发硬膜下血肿。
我们讨论一例26岁女性病例，该患者在硬膜外麻醉下行阴道分娩后出现前额部头痛。鉴别诊断包括脊髓性头痛、产后高凝状态、硬脑膜窦血栓形成以及颅内出血或肿块。她的生命体征和体格检查均正常。脑部计算机断层扫描显示沿左额叶大脑半球有急性硬膜下血肿，无中线移位或占位效应。进行了血液填充治疗，其症状完全缓解。
本病例说明了在硬膜外麻醉用于分娩疼痛管理后的产后时期发生急性硬膜下血肿的罕见情况。认为这是由硬膜外麻醉后颅内低压和脑脊液漏引起的。
