Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome.
OBJECTIVE
To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour.


METHODS
This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000 x microL-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 x micro L-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.


CONCLUSIONS
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.
Ezri
Tiberiu
T
Department of Anesthesiology, Wolfson Medical Center, Holon, Israel. etb@netvision.net.il
Abouleish
Ezzat
E
Lee
Charles
C
Evron
Shmuel
S
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D017359:HELLP Syndrome / Q000150:complications*; D006261:Headache / Q000209:etiology; D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D011247:Pregnancy