Cephalic migration of spinal subdural hematoma following spinal anesthesia for cesarean section: A rare case report

Background: Spinal subdural hematomas (SSDHs) are rare and potentially disabling complications of neuraxial anesthesia. Cephalic migration of spinal hematomas from the lumbar puncture site extending to the cervical or thoracic regions is even less frequently encountered, especially in postpartum patients. Case Description: A 28-year-old postpartum female developed acute spastic paraparesis 1 day following spinal anesthesia for an emergency cesarean section. The spinal puncture was attempted twice at the L3-L4 interspace. The magnetic resonance imaging of the lumbar spine revealed hemorrhagic fluid-fluid levels at both the L5-S1 and S1-S2 levels, while the cervicodorsal imaging demonstrated a C6-D5 subdural hematoma resulting in significant cord compression and hyperintense cord signal changes. The patient underwent an emergent decompressive laminectomy for hematoma evacuation from C7 to D4 after which she made a progressive and complete recovery over 6 postoperative months. Conclusion: Cephalic migration of SSDH following spinal anesthesia is rare. It is critical to obtain complete spinal imaging in postpartum patients presenting with new neurological deficits following spinal anesthesia and to immediately perform operative decompression to maximize neurological recovery.