Chronic Subdural Hematoma Complicated Spinal Anesthesia: Report and Pilot Study of Five Surgically Treated Cases

Abstract

Background: Spinal anesthesia (SA) is generally considered a simple and safe procedure, but post spinal headache is a very common symptom appears later SA. Appearance of cranial subdural hematoma after SA is a very rare but life-threatening complication state. PDPH is the primary symptom of hematoma formation, and it should be regarded as a warning sign. Differentiation between subdural hematoma and PDPH may be difficult. Substitutional diagnoses for PDPH should be considered whenever the headache is severe, prolonged or not related to patient position. PDPH should be investigated immediately to exclude any intracranial complications.Objective: The objectives of this study are to increase awareness of hemorrhagic complications following SA and assess post-SA headache to encourage early diagnosis and management. Methods: The study was a pilot study of five cases. Four cases involved postpartum patients after SA who developed small to large subdural hematomas, as assessed by full neurological examination and neurological studies, and one case involved an elderly patient with a stone ureter.Results: One patient was managed conservatively, and the other four patients improved after surgical evacuation.Conclusions: Alternative diagnoses to post spinal headache must be considered for severe, prolonged headaches that are not related to patient position and do not respond to bed rest and analgesia. Early assessment of PDPH and early neuroradiological evaluation are recommended to diagnose post-SA subdural hematoma for early intervention to prevent avoidable morbidity and mortality.