Case report: difficulty in diagnosis of delayed spinal epidural hematoma in puerperal women after combined spinal epidural anaesthesia

Abstract

Background Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurological impairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinical presentation of spinal epidural hematoma is even rarer and insidious. Case presentation We reported a case of a 44-year-old woman who underwent a caesarean section for a twin pregnancy during which a delayed dorsal spinal epidural hematoma occurred. Symptoms were reported 5 days after surgery and 72 h after removal of the epidural catheter. An MRI scan showed a dorsal epidural hematoma. The patient was moved to the Neurosurgical Department and underwent decompression surgery. Conclusion The possibility of the delayed onset of a spinal epidural hematoma in a pregnant woman who undergoes epidural anaesthesia in labour must always be taken into consideration. In order to achieve the best clinical result, we stress the importance of a timely diagnosis and prompt surgical treatment.

Postpartum complications following neuraxial anaesthesia for obstetric physicians

“…65 Symptom onset may post-date catheter removal by several days. 66,67 Early recognition of haematoma formation and neurological sequelae is critical as immediate surgical decompression is required, optimal neurologic outcomes occurring with surgery within 12 h of initial symptoms. 68 Emergency MRI (or CT if MRI is not available/contraindicated) should be performed if SEH is considered.…”

Peripartum neurological complications: implications and management

“…She eventually underwent a decompression laminectomy, and gained partial recovery of her deficits. 31 Identifying who is at the highest risk of developing an epidural hematoma is important. Thrombocytopenia is a condition that has often been an indication for an anesthesiologist to refuse administration of neuraxial analgesia in a laboring patient.…”

“…More than 70 hours after removal of the epidural catheter, the patient described low back pain with radiation, urinary retention, and eventually a lower limb motor deficit several hours later. She eventually underwent a decompression laminectomy, and gained partial recovery of her deficits 31…”

Spontaneous spinal epidural hematoma (SSEH) after cesarean section under epidural anesthesia: A case report

“…Spontaneous spinal epidural hematoma (SSEH) is an exceedingly rare condition, with an estimated annual incidence of approximately 0.1 per 100,000 in adults [ 1 ]. SSEH is characterized by its acute onset, potentially leading to catastrophic compression of neural tissue, either through direct injury or ischemia [ 2 ], necessitating immediate surgical intervention upon the emergence of neurological dysfunction [ 3 ]. Various gestational complications, including thrombocytopenia or preeclampsia [ 2 ], and the epidural vascular dilation [ 4 ], can amplify the risk of SSEH.…”

“…SSEH is characterized by its acute onset, potentially leading to catastrophic compression of neural tissue, either through direct injury or ischemia [ 2 ], necessitating immediate surgical intervention upon the emergence of neurological dysfunction [ 3 ]. Various gestational complications, including thrombocytopenia or preeclampsia [ 2 ], and the epidural vascular dilation [ 4 ], can amplify the risk of SSEH. Furthermore, the use of intraspinal anesthesia and analgesic techniques can obscure neurological manifestations, thereby complicating early diagnosis [ 5 ].…”