A Fatal Case Of Subdural Hematoma: A Complication Of Epidural Analgesia

摘要

A 26 year old woman received epidural analgesia for an uneventful spontaneous vaginal delivery. Two weeks later, she presented with a headache with initial impression of spinal headache and received pain medication, to which she responded well. One week later, she presented with a similar headache. Due to her persistent symptoms, CSF leak was suspected. She received epidural blood patch that relieved her symptoms. Two weeks after the last discharge, the patient was received in the hospital in the state of altered mental status following a cardiac arrest. As per the family, one day prior, she had a brief loss of consciousness. On the morning of the presentation, she was found unresponsive in the bed. Emergency Medical Services found the patient in cardiac arrest. Cardiopulmonary resuscitation (CPR) resumed her circulation in 30 minutes. Upon arrival in the hospital, Computed Tomography (CT) scan of the head was promptly done that showed bilateral subacute subdural hematomas with mass effect. The patient was declared brain dead the next day. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anesthesia should prompt the consideration of [any care provider] the existence of intracranial complications and radiological diagnosis should be obtained.