A Rare Complication After Spinal Anesthesia: Intracranial Subdural Hematoma

Acute & chronic intracranial subdural hematoma is usually caused by trauma. However, it is a rare and serious complication after spinal anesthesia. A 38-year-old woman was brought to the emergency department by her relatives with complaints of sudden change in consciousness. It was learned that the patient gave birth by cesarean section under spinal anesthesia 3 days ago. It was anamnesized that there was no abnormality in the operation, the patient had a headache during the follow-up in the service and was diagnosed as post-dural puncture headache, analgesics were prescribed and she was discharged with recommendations. It was determined that the headaches continued after discharge and sudden change in consciousness occurred 2 hours after discharge. On physical examination, the patient was intubated because of poor general condition and Glasgow coma scale score of 8. The patient had 4/2 anisocoria on the left side. A brain CT scan showed a 6 mm subacute subdural hematoma in the left frontotemporoparietal region at the widest part. There was an 8 mm shift effect to the right of the midline, the sulci were obliterated and the cerebral tissue was mildly edematous. The patient was consulted to neurosurgery because of subacute subdural hematoma, shifting and anisocoria and was transferred to neurosurgery intensive care unit for emergency craniotomy and hematoma evacuation. This case report describes an acute subdural hematoma after spinal anesthesia and emphasizes that when using spinal anesthesia, it should be kept in mind that headache does not always mean hypotensive headache associated with spinal anesthesia and that a catastrophic complication of subdural hematoma may also occur.