Seizures after epidural blood patch with undiagnosed subdural hematoma.
OBJECTIVE
We present a case of new-onset seizures in a parturient who received an epidural blood patch (EBP) in the presence of an undiagnosed cerebral subdural hematoma. We review the relevant literature and examine the implications for management.


METHODS
A 33-year-old parturient developed symptoms of postdural puncture headache 16 hours after initiation of epidural analgesia for labor. On the third postpartum day, she likely had an unwitnessed and unrecognized seizure. Presenting to hospital with headache and fatigue, she received an EBP. Forty-five minutes after the EBP, she had a generalized seizure followed by another 2 hours later. Imaging revealed a small cranial subdural hematoma. She had no further seizures, her headache improved, and she was discharged home on postpartum day 5.


CONCLUSIONS
We believe that the subdural hematoma and not the EBP was the cause of the seizures. Earlier recognition of confusion and fatigue as a postictal state may have led to earlier diagnosis of the hematoma. Our experience suggests that EBP be avoided in the setting of subdural hematoma.
Kardash
Kenneth
K
Department of Anaesthesia, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. kkardash@ana.jgh.mcgill.ca
Morrow
Farrah
F
Béïque
Francois
F
D000328:Adult; D017217:Blood Patch, Epidural / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000150:complications; D006408:Hematoma, Subdural / Q000150:complications*; D006801:Humans; D012640:Seizures / Q000209:etiology*