The occurrence of spinal subarachnoid hematoma (SSH) after lumbar puncture for anesthesia is a rare complication and in most cases results from difficult spinal anesthesia. Predisposing factors are: presence of tumors or vascular malformations within the spinal canal, coagulopathies, use of antiplatelet and/or anticoagulant therapy, direct spinal cord trauma, spinal canal stenosis, combined spinal anesthesia, multiple and difficult traumatic punctures. We report a case of a patient which after spinal anesthesia for orthopedic surgery developed cauda equina syndrome postoperatively. The patient was submitted to lumbosacral MRI and diagnosed with SSH. Emergency surgical treatment was performed, with clinical and neurological improvement in the immediate postoperative period. A review of the literature was conducted aiming to discuss the pathophysiology and etiological factors involved, as well as aspects related to the diagnosis, treatment and prognosis of this rare clinical condition.

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