Abstract
Purpose
To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour.
Clinical features
This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000·μL−1) who subsequently developed the syndrome of hemolysis, elevated liver enzymes and low platelets. On the first postoperative day, postdural puncture headache (PDPH) developed. An epidural blood patch (EBP) was deferred to the third postoperative day because of a platelet count of 21,000·μL−1. However, the headache intensified from a typical PDPH to one which was not posturally related. A second EBP was abandoned after the injection of 5 mL of blood because of increasing headache during the procedure. Magnetic resonance imaging revealed bilateral temporal subdural hematomas. The patient was managed conservatively and discharged home without any sequelae.
Conclusion
It is conceivable that thrombocytopenia together with possible abnormal platelet function increased the risk of subdural hematoma. Alternative diagnoses to PDPH should be considered whenever headache is not posturally related.
Résumé
Objectif
Présenter un cas d’hématome sous-dural intracrânien bilatéral du postpartum à la suite d’une ponction durale pendant l’administration d’analgésie épidurale pour le travail obstétrical.
Éléments cliniques
La complication est survenue après une ponction durale chez une parturiente qui présentait une thrombocytopénie (99 000·μL−1) et chez qui s’est ensuite développé un syndrome d’hémolyse, d’enzymes hépatiques élevés et d’un faible taux de plaquettes. Au premier jour postopératoire, la patiente a subi des céphalées post-ponction durale (CPPD). Un colmatage sanguin épidural (CSE) a été reporté au troisième jour postopératoire, étant donné la numération plaquettaire à 21 000·μL−1. Cependant, les céphalées ont augmenté jusqu’à n’avoir plus de lien avec la position du corps. Un second CSE a été abandonné après l’injection de 5 mL de sang, l’intervention augmentant la céphalée. L’imagerie par résonance magnétique a révélé des hématomes sous-duraux, temporaux, bilatéraux. La patiente a reçu un traitement conservateur et a quitté l’hôpital sans séquelles.
Conclusion
On peut imaginer qu’une thrombocytopénie combinée à une dysfonction plaquettaire possible pourra accroître le risque d’hématome sous-dural. Il faut envisager un autre diagnostic que la CPPD chaque fois que la position n’est pas en cause.
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Ezri, T., Abouleish, E., Lee, C. et al. Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome. Can J Anesth 49, 820–823 (2002). https://doi.org/10.1007/BF03017415
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DOI: https://doi.org/10.1007/BF03017415