A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

Abstract

Spinal anestezi sonrası intraserebral hematom çok nadir görülen bir nöro-lojik komplikasyondur ve dura ponksiyonu sonrasında oluşan intraserebral hematomun mekanizması bilinmemektedir. Herhangi bir nörolojik ve koagülasyon bozukluğu olmayan ve transüretral prostatektomi planlanan 87 yaşındaki erkek hastaya spinal anestezi uygulandı. Spinal enjeksiyondan yaklaşık 2,5 saat sonra baş ağrısı, konuşmada bozulma ve somnolans gelişen hastanın beyin CT'de intraserebral hematom tespit edildi. Yoğun bakım ünitesinde entübe edilerek mekanik ventilasyona bağlandı. Hasta postoperatif 6. gün öldü. Spinal anestezi sonrası erken dönemde gelişen nörolojik bozuklukta geri dönüşsüz beyin hasarının gelişebileceği akla gelmeli ve zaman kaybetmeden radyolojik olarak araştırılmalıdır.Anahtar Kelimeler: Spinal anestezi, dura delinmesi, intraserebral hematom Intracerebral haematoma following spinal anaesthesia is a very uncommon neurologic complication and the mechanism of intracerebral haematoma following dural puncture is not known. An 87-year-old man, who did not have any neurologic or coagulation disorder, received spinal anaesthesia for transurethral prostatectomy. Approximately 2.5 hours after spinal injection, he developed headache, slurred speech and somnolence, and brain CT revealed intracerebral haematoma. The patient was admitted to the intensive care unit and was intubated and connected to mechanical ventilator. The patient died on the 6 th postoperative day. It should be kept in mind that irreversible brain damage can develop in neurological disorders that develop soon after spinal anaesthesia and that these should be promptly evaluated radiologically.Key Words: Spinal anaesthesia, dural puncture, intracerebral haematoma Introduction N eurological complications following spinal or epidural blocks have increasingly been reported in recent years. Neurological complications that can occur following spinal anaesthesia include headache, hearing loss, epidural, subdural or subarachnoid haemorrhage, epidural abscess, and intracranial hypotension (1-4). Among these complications, intracranial haemorrhage is a relatively uncommon but fatal complication (4). In the current case, we present development of intracerebral haematoma following spinal anaesthesia, which culminated with mortality. Case ReportThe patient was an 87-year-old man who had a history of hypertension for 10 years and chronic obstructive pulmonary disease for 8 years. He underwent transurethral prostatectomy surgery under spinal anaesthesia. He had no history of known cerebrovascular disease, head trauma or headache. Physical examination and neurologic evaluation of the patient were not significant. Blood tests including coagulation were within reference ranges.Oral antihypertensive medication was continued in the preoperative period. After cannulation of a peripheral vein, 500 mL of 0.9% isotonic saline was infused within 30 minutes in the premedication room. The patient was transferred to the operation room and routine monitoring was conducted. The patient's non-in...

A case of late diagnosis of chronic subdural hematoma following spinal anesthesia

“…Subdural hematoma is a rare complication of spinal anesthesia [1], [2], [7]. Excessive dural puncture-related CSF leak following spinal anesthesia may lead to causal displacement of the brain.…”

“…Complications of spinal anesthesia include postdural puncture headache, intracranial hypotension, meningitis, spinal hematoma, sensory loss and paraplegia, intracranial (epidural, subdural or subarachnoid) bleeding, epidural abscess, infection in the puncture site and cranial nerve deficits. Subdural hematoma is a rare complication of spinal anesthesia [1] , [2] , [7] . Excessive dural puncture-related CSF leak following spinal anesthesia may lead to causal displacement of the brain.…”

“…Intracranial subdural hematoma developing following spinal anesthesia is a rare but serious complication [1] , [2] . Moen et al.…”