Poster 378 Rehabilitation of a Patient with Partial Cauda Equina Syndrome and Intracranial Hemorrhages following Spinal Anesthesia for a Knee Replacement: A Case Report

Mascarinas, Angelie; Herman, Seth

doi:10.1016/j.pmrj.2014.08.757

Cited by 1 publication

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“…Intracranial hematoma after neuraxial block was reported in 291 patients (226 articles); 9 patients suffered from a combination of spinal and intracranial hematoma. [15][16][17][18][19][20][21][22][23] Intracranial abscess was reported in six patients (six articles); one patient suffered from both spinal and intracranial abscesses. 24 Data collection and selection of articles are described in figure 1.…”

Section: Resultsmentioning

confidence: 99%

Intracranial hematoma and abscess after neuraxial analgesia and anesthesia: a review of the literature describing 297 cases

Bos

Lee

Haumann

et al. 2021

Reg Anesth Pain Med

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BackgroundBesides spinal complications, intracranial hematoma or abscess may occur after neuraxial block. Risk factors and outcome remain unclear.ObjectiveThis review evaluates characteristics, treatment and recovery of patients with intracranial complications after neuraxial block.Evidence reviewWe systematically searched MEDLINE, Embase and the Cochrane Library from their inception to May 2020 for case reports/series, cohort studies and reviews of intracranial hematoma or abscess associated with neuraxial block. Quality of evidence was assessed using the critical appraisal of a case study checklist by Crombie.FindingsWe analyzed 232 reports, including 291 patients with hematoma and six patients with abscess/empyema. The major part of included studies comprised single case reports with a high risk of bias. Of the patients with hematoma, 48% concerned obstetric patients, the remainder received neuraxial block for various perioperative indications or pain management. Prior dural puncture was reported in 81%, either intended (eg, spinal anesthesia) or unintended (eg, complicated epidural catheter placement). Headache was described in 217 patients; in 101 patients, symptoms resembled postdural puncture headache (PDPH). After treatment, 11% had partial or no recovery and 8% died, indicating the severity of this complication. Intracranial abscess after neuraxial block is seldom reported; six reports were found.ConclusionDiagnosis of intracranial hematoma is often missed initially, as headache is assumed to be caused by cerebrospinal hypotension due to cerebrospinal fluid leakage, known as PDPH. Prolonged headache without improvement, worsening symptoms despite treatment or epidural blood patch, change of headache from postural to non-postural or new neurological signs should alert physicians to alternative diagnoses.

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