Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco‐abdominal aneurysm

Abstract

SummaryA patient who was suffering an exacerbation of myasthenia gravis dislocated her elbow. She underwent closed reduction of the dislocation under vertical infraclavicular brachial plexus blockade. The technique was successful but was associated with a 29% decrease in forced vital capacity, from 1.7 l to 1.2 l. The patient did not show any symptoms of ventilatory failure. Her recovery was uncomplicated.

Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: A report of 486 patients treated from 1987 to 2008

“…Subdural 27,28 and intraparenchymal 29 intracranial hematoma are recognized complications of spinal fluid drainage after TAAA repair. In the series of 230 patients reported by Dardik et al, 28 draining a larger volume of fluid (690 vs 359 mL) in the perioperative period increased the risk that a subdural hematoma would develop.…”

Acute Intracranial Subdural Hematoma Following a Lumbar CSF Leak Caused by Spine Surgery

“…1,2 It has been reported after myelography, lumbar puncture, ventricular shunt placement, CSF drains placed during aortic aneurysm procedures, spinal anesthesia, spine surgery, craniotomy, and spine trauma. [1][2][3][4][5] In the majority of cases, symptoms resolve spontaneously without intervention. Intracranial hypotension, however, has also been associated with the development of acute subdural hemorrhage in the intracranial compartment, presumably as a result of traction on venous structures after a rapid drop in intracranial pressure.…”

Intracranial hemorrhage associated with cerebrospinal fluid drainage during thoraco-abdominal aortic surgery

“…Several incidents of intracranial subdural hematomas after spinal anesthesia have been also reported [7][8][9], but these complications reported after CSFD were rare [10][11][12][13]. 1 Emergency CT of the brain showed a subdural hematoma in the right temporal area, an intraparenchymal hemorrhage in the left occipital lobe, a subarachnoid hemorrhage, and brain swelling One postulated mechanism to explain ICH involves a loss of spinal fluid reducing intracranial pressure, leading to enlargement of the dural venous sinuses, followed by intracranial hypotension which can stretch and rupture large cortical veins crossing the subdural space, and finally resulting in bleeding which occurs in the subdural and also subarachnoid spaces.…”