Bilateral chronic subdural hematomas with neurologic symptoms complicating spinal anesthesia.
OBJECTIVE
Intracranial subdural hematoma is a rare but potentially fatal complication of spinal anesthesia (SA). This case is intended to highlight the importance of careful follow-up of patients with a chronic headache that develops after SA.


METHODS
A 38-year-old woman underwent saphenous vein ligation for varices under SA. On the first postoperative day, she complained of severe postural headache that was controllable with oral analgesics. Two weeks later, bilateral abducens nerve palsy with diplopia developed. Brain magnetic resonance imaging (MRI) showed small bilateral subdural hygromas. Diplopia and headache (no longer postural) were relieved after administration of dexamethasone, but reappeared 6 wks later. This time, MRI showed large subdural hematomas. The patient was treated with burr-hole decompression.


CONCLUSIONS
Persistent headache after SA requires careful neurologic and radiologic follow-up for exclusion of chronic intracranial bleeding. Pharmacologic treatment may mask some neurologic symptoms and delay diagnosis of intracranial complications related to SA.
Slowinski
Jerzy
J
Department of Neurosurgery and Neurotraumatology, Medical University of Silesia, Al Legionow 10, 31-902 Bytom, Poland. slowian@mp.pl
Szydlik
Wieslaw
W
Sanetra
Agata
A
Kaminska
Irena
I
Mrowka
Ryszard
R
D020222:Abducens Nerve Injury / Q000209:etiology; D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002908:Chronic Disease; D019299:Decompression, Surgical; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004172:Diplopia / Q000209:etiology; D005260:Female; D006261:Headache / Q000209:etiology; D020200:Hematoma, Subdural, Chronic / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008026:Ligation; D008279:Magnetic Resonance Imaging; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012501:Saphenous Vein
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone