Abstract Details

Title Postpartum Subdural Hemorrhage after Epidural Anesthesia

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 219

Objective

Background BACKGROUND: Postpartum headache can be a symptom of a potentially severe neurological disorder such as cortical venous/sinus thrombosis,subarachnoid hemorrhage,or eclampsia.Post epidural anesthesia subdural hemorrhage(PeaSDH)is a rare cause of postpartum headache,but clinicians should be aware of this cause of headache.We describe a case of PeaSDH and report it in the context of previously published cases to discern the distribution of presenting signs and symptoms as well as associated outcomes.

Design/Methods DESIGN/METHODS: Case report and literature search utilizing Pubmed.Cases published between 1979-2011 and our case was incorporated into the review.Abstracted data included:patient demographics,reason for epidural,time to onset of headache,time to first brain imaging study,and patient outcome.

Results RESULTS: Between 1979 and 2011, 43 cases with PeaSDH were published.Age range of patients was 15-88years old, and the majority were women (n=30; 68%).The most common indication for EA was obstetrical(n=18; 41%).The majority had headache onset by 72 hours following PeaSDH(n=32;73%).Isolated headache was present in 13(30%).Focal neurological symptoms in the remainder were variable and included hemiparesis,cranial neuropathy,seizure,papilledema,and cognitive changes.Coma or rapid progression to death occurred in 4cases(9%).Treatment included surgical drainage in 33(75%),conservative management in 11(25%).

Conclusions CONCLUSIONS: The majority of PeaSDH cases in women reported thus far have been associated with obstetrical delivery and procedures.Headache is typically present and headache onset is usually within the first few days following EA.Clinicians should include SDH in their differential of postpartum headache and have a low threshold to conduct a brain imaging study when they suspect its presence.PeaSDH often requires neurosurgical intervention.Delay in diagnosis may have grave consequences.SDH associated with epidural anesthesia is likely induced by accidental puncture of the dura with a resultant CSF leak.Low CSF pressure produced by this leak may lead to traction and tearing of thin-walled meningeal blood vessels in the brain.

Authors/Disclosures
Farhad K. Elyaderani, MD PRESENTER	No disclosure on file
Scott L. Silliman, MD (U.F. College of Medicine-Jacksonville)	Dr. Silliman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech.
Jeffrey A. Cohen, MD (Cleveland Clinic)	Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.

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