Abstract

Introduction: Intracranial Subdural Hematoma (SDH) is a rare complication after spinal anesthesia, diagnosis is most often difficult. Objective of the work to report the case of a SDH post spinal anesthesia for cesarean section.

Observation: 29-year-old patient without medical ATCDS, already operated on by caesarean section under spinal anesthesia without incident, the preoperative biological assessment was without anomalies, the spinal anesthesia was performed in a half-sitting position in a single attempt, the intraoperative period was uneventful incidents. On postoperative day 1, onset of headaches on emergence, treated with perfalgan then caffeinated paracetamol per os and rehydration, she left the clinic with 8-day thromboprophylaxis. At the 10th reappearance of the headaches, the patient sees her gynecologist again who prescribes aspegic 100mg. The headaches become resistant to treatment and appearance of visual blurring of the right eye, seen by an ophthalmologist whose examination was normal. He completes the exploration with a cerebral CT scan which reveals a 14mm right hemispherical subdural hematoma with commitment under falcoriel. The hematoma was drained by two burr holes under sedation with placement of a drain The postoperative follow-up was favorable with a cerebral CT scan after removal of the drain showing the absence of a residual collection. A CT angiography eliminated an arteriovenous malformation and a dosage of coagulation factors returned without abnormalities.

Discussion: Intracranial SDH is a rare complication after spinal anesthesia, its ignorance can lead to serious or even fatal sequelae. Its physiopathology is explained by a persistence of the hard merian breach leading to intracranial hypotension causing a displacement of the neuraxis, from various causes. The reported case clearly illustrates that the first manifestations are identical to post-dural puncture headaches.

Conclusion: Severe and progressive headache after spinal anesthesia should be considered as an alert for an intracranial complication: post-spinal anesthesia subdural hematoma is a rare but important complication to be aware of by all practitioners in view of its severity.