Bilateral subdural hematoma after inadvertent dural puncture during epidural analgesia.

Roman Nepomuceno, Anthony Herd

University of Manitoba, Winnipeg, Manitoba, Canada.

The Journal of emergency medicine 2013 Feb

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Post-dural puncture headache (PDPH) is typically a benign complication of dural puncture that is clinically diagnosed. It commonly presents as a throbbing and positional headache that occurs 24-48 h after dural puncture. Subdural hematomas, if unrecognized, may occur as a rare and life-threatening complication of dural puncture. We aim to describe the clinical features and sequelae of a rare complication that may result as a consequence of inadvertent dural puncture that, if unrecognized, has the potential to become a life-threatening complication from a common procedure. We report the case of a previously healthy 17-year-old primigravida female who initially presented 4 days postpartum with clinical features and imaging studies consistent with PDPH. The patient's symptoms were unremitting, and within 4 weeks, she developed bilateral subdural hematoma. With prompt recognition and diagnosis, she was treated with conservative medical management and subsequently improved on follow-up. Patients with unremitting PDPH should prompt the clinician to suspect the development of subdural hematoma as a potential life-threatening complication of an otherwise benign condition. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Citation

Roman Nepomuceno, Anthony Herd. Bilateral subdural hematoma after inadvertent dural puncture during epidural analgesia. The Journal of emergency medicine. 2013 Feb;44(2):e227-30