Zusammenfassung
Eine intrazerebrale Blutung ist eine extrem seltene Komplikation nach einer Sectio caesarea in Spinalanästhesie. Eine 37-jährige Nullipara ohne anamnestisch bekannte Vorerkrankungen unterzog sich nach unauffälliger Zwillingsschwangerschaft einer eiligen Sectio caesarea bei Plazentainsuffizienz in Spinalanästhesie mit hyperbarem 0,5%igem Bupivacain (13,5 mg) und einer Sprotte-Nadel 27 Gauge. Die Patientin klagte 80 min nach dem Eingriff über starke Kopfschmerzen, konnte kurz danach den rechten Arm nicht mehr bewegen und trübte schnell ein. Das unverzüglich durchgeführte kranielle Computertomogramm (CCT) zeigte eine große intrazerebrale Blutung der linken Hemisphäre mit Masseneffekt. Es erfolgte eine temporoparietale Kraniotomie zur Hämatomausräumung. Ursächlich fanden sich weder ein Angiom noch eine arteriovenöse Malformation. Die Patientin erwachte und konnte nach 32 h von der Beatmung entwöhnt werden. Am 7. postoperativen Tag fand sich noch eine Aphasie mit Hemiparese des rechten Arms als neurologisches Restdefizit. Auch 6 Monate später hat sich der neurologische Zustand nicht deutlich gebessert. Der Fall wird anhand der aktuellen Literatur diskutiert.
Abstract
Intracerebral haemorrhage is a rare complication of spinal anaesthesia in obstetrics. A 37-year-old woman without any accompanying disease during a twin pregnancy, underwent an urgent caesarean section due to insufficiency of the placenta under spinal anaesthesia using hyperbaric bupivacain (0.5%) and a pencil-point spinal needle Sprotte 27 Gauge. The patient developed severe headache, a hemiparesis of the right upper limb and became somnolent and finally unconscious 80 min after the procedure. An immediately performed computed tomographic scan revealed a large acute intracerebral haemorrhage in the left hemisphere region with mass effect. The patient underwent temporoparietal craniotomy. No obvious cause of the haemorrhage, such as aneurysm or arteriovenous malformation was found. The patient fully recovered and was weaned from the respirator 32 h postoperatively. On postoperative day 7 the remaining neurologic deficits included aphasis and severe hemiparesis of the right upper limb and a right extensor plantar response. The neurologic status did not improve substantially until 6 months after the complication. The case and the recent literature are discussed.
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von Knobelsdorff, G., Paris, A. Intrazerebrale Blutung nach Sectio ceasarea in Spinalanästhesie. Anaesthesist 53, 41–44 (2004). https://doi.org/10.1007/s00101-003-0585-9
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DOI: https://doi.org/10.1007/s00101-003-0585-9