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Subdural hematoma after atraumatic spinal.

Landman UN, Jerome RM, Glass PS

Department of Anesthesiology, Stony Brook Health Sciences Center, School of Medicine, Stony Brook, NY 11794-8480, USA. ulandman@notes.cc.sunysb.edu

We report a case of subdural hematoma in a 68-year-old white man who underwent left inguinal hernia repair with spinal anesthesia. The patient had a postdural puncture headache (PDPH) on postoperative day 4, but he refused invasive treatment. Instead, he self-administered acetaminophen, aspirin, and caffeine. On postoperative day 11, he was diagnosed with a subdural hematoma. At 49 days postoperatively, a computed axial tomographic scan was taken, the results of which were normal, after no surgical intervention. This patient had none of the risk factors as reported in the literature for this rare complication. Although a headache postoperatively, after spinal anesthesia, is often assumed to be PDPH, clinicians should not rule out the possibility of subdural hematoma, especially if the headache is persistent. We advise that the smallest-bore spinal needles be used when administering spinal anesthesia and that patients be carefully evaluated before their surgery for use of anticoagulants, herbal medications, or history of cerebrovascular disease. Immediate treatment of the PDPH with an epidural blood patch should be considered. If a patient refuses invasive treatment, he should be counseled for the possibility of subdural hematoma. The patient also should be advised to avoid medications with anticoagulant properties.

Published 16 August 2005 in J Clin Anesth, 17(5): 379-81.
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