A case report on intracranial subdural hematoma following spinal anesthesia: A rare complication of a common procedure

Abstract Introduction: Intracranial subdural hematoma is a rare complication of lumbar puncture and spinal anesthesia. The presenting symptoms mimic other benign conditions such as post dural puncture headache which often led to mis-and delayed-diagnoses. With high degree of suspicion and proper intervention fatal outcomes can be avoided. Case presentation: A 36-year-old HIV+ primigravida mother underwent a cesarean section under spinal anesthesia for an indication of non-reassuring fetal heart rate two weeks back. After the procedure, she reported mild occipital headache which was precipitated by upright postural. With a diagnosis of post dural puncture headache, conservative management was started and her headache subsequently improved. On day four, both the mother and her baby discharged home. A week later the patient developed occipital headache which gradually worsen and become unremitting with associated diplopia, blurred vision, neck pain and vomiting which forced her to visit the emergency department at Tikur Anbessa Specialized Hospital. Except moderate nuchal rigidity her physical examination was unremarkable. Brain imaging was requested and revealed bilateral acute and subacute subdural hematoma without mass effect. After neurosurgical consultation, conservative management with bed rest, hydration and oral analgesics was initiated. On day ten her headache and other symptoms significantly improved. She was discharged with outpatient follow-up. Conclusion: Clinicians should be vigilant about the evolving nature of post dural puncture headache and the possibility of intracranial subdural hematoma when patients presented with persistent or worsening headache which becomes non-positional following dural puncture and spinal anesthesia. Early detection and proper intervention are imperative to avoid permanent disability or mortality.