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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596


Minerva Anestesiologica 2010 Dicembre;76(12):1091-4


Acute subdural intracranial hematoma after combined spinal-epidural analgesia in labor

Abbinante C. 1, Lauta E. 1, Di Venosa N. 1, Ribezzi M. 1, Colamaria A. 2, Ciappetta P. 2

1 Anesthesia and Intensive Care Unit I, A.O.U. Policlinico Consorziale, Bari, Italy;
2 Department of Neurosciences, Section of Neurosurgery, University of Bari Medical School, Bari, Italy

Intracranial subdural hematoma is a rare, but well-described complication of epidural and spinal anesthesia, as documented by more than a decade of publications. Non-postural headache and vomiting are warning signs. A headache lasting more than 5 days should arouse suspicion of intracranial hemorrhage, whether or not it is associated with the appearance of neurological signs or the deterioration of neurological status. Urgent cranial computed tomography can confirm the diagnosis of subdural hematoma, which has the potential to cause a dramatic cerebral herniation syndrome. A combination of spinal epidural (CSE) anesthesia and analgesia is commonly used to obtain pain relief during caesarean sections and labor. We report the case of a patient who suffered from severe neurological deterioration and manifested signs of brain herniation due to the development of an acute intracranial subdural hematoma after CSE analgesia for labor. An emergency craniotomy was performed to remove the subdural hematoma and the patient recovered well. Close observation of patients undergoing CSE analgesia or anesthesia complaining of prolonged non-postural headaches, with or without neurological symptoms, is recommended.

lingua: Inglese


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