Reactions 1306 - 19 Jun 2010

SBupivacaine

Post-dural puncture headache leading tosubdural haematoma: case report

A 39-year-old woman developed post-dural punctureheadache (PDPH), leading to cerebral subdural haematomaafter receiving spinal anaesthesia with bupivacaine for acaesarean section.

The woman underwent elective caesarean section with0.5% bupivacaine 12mg. The procedure was uneventful,apart from a drop in her systolic blood pressure requiringephedrine. Three days later, she reported a mild occipitalheadache that worsened in a sitting position; PDPH wassuspected. With bed rest and hydration, her headacherapidly improved over the following 2 days, and she wasdischarged 5 days after her caesarean. The following day,she developed headache with fifth nerve palsy and tearingof her right eye. Intense orbital pain on her right side anddiplopia developed on post-operative day 15, and she washospitalised on day 30 after developing left-sidedweakness. On examination, left-sided limb weakness wasobserved, as well as severe non-postural headache andright eye pain. Cerebral subdural haematoma involving herright fronto-parietal lobe was detected on CT scan, and wasestimated to be more than 2 weeks old.

The woman received conservative treatment, and hersymptoms subsequently improved. Repeat CT scanrevealed resolution of her haematoma 11 days later, andshe was discharged the following day. A full recovery wasnoted 12 weeks following dural puncture.

Author comment: "In conclusion, our patient developed acranial subdural hematoma following untreated PDPH."Zeidan A, et al. Does postdural puncture headache left untreated lead to subduralhematoma? Case report and review of the literature. Middle East Journal ofAnesthesiology 20: 483-92, No. 4, Feb 2010 - Lebanon 803020374

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Reactions 19 Jun 2010 No. 13060114-9954/10/1306-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved