Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States.
Department of Emergency Medicine, Carilion Clinic, 1906 Bellview Ave SE, Roanoke, VA 24014, United States.
Am J Emerg Med. 2024 Sep;83:162.e5-162.e7. doi: 10.1016/j.ajem.2024.06.032. Epub 2024 Jun 25.
Subdural hematoma is an uncommon complication of epidural analgesia or diagnostic lumbar puncture. Headache is a common complaint for patients with either a subdural hematoma or a post-dural puncture headache. Because post-dural puncture headaches are commonly seen in the Emergency Department, the potential to miss more serious pathology arises. We present the case of a young female who suffered bilateral subdural hematomas following epidural analgesia during childbirth. She presented twice to the Emergency Department and was treated for a post-dural puncture headache before computed tomography imaging revealed the diagnosis on the third Emergency Department encounter. This case highlights the importance of exploring all potential diagnoses when a patient presents with a headache after either epidural analgesia or a diagnostic lumbar puncture, especially if the patient returns after unsuccessful treatment for a presumptive post-dural puncture headache.
硬膜外血肿是硬膜外镇痛或腰椎穿刺诊断的罕见并发症。头痛是硬膜外血肿或腰穿后头痛患者的常见主诉。由于腰椎穿刺后头痛在急诊科很常见，因此可能会漏诊更严重的病变。我们报告了一例年轻女性在分娩时接受硬膜外镇痛后出现双侧硬膜外血肿的病例。她两次到急诊科就诊，因腰穿后头痛接受治疗，直到第三次到急诊科就诊时，计算机断层扫描成像才显示出诊断。该病例强调了当患者在硬膜外镇痛或腰椎穿刺后出现头痛时，尤其是在对疑似腰穿后头痛进行不成功治疗后返回时，应探讨所有潜在诊断的重要性。
