Subarachnoid and intraventricular hemorrhage due to ruptured aneurysm after combined spinal-epidural anesthesia.
A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm.
Chun
Duk-Hee
DH
Department of Anesthesiology & Pain Medicine, Anesthesia & Pain Research Institute, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.
Kim
Na-Young
NY
Shin
Yang-Sik
YS
D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D017542:Aneurysm, Ruptured / Q000139:chemically induced* / Q000150:complications*; D002552:Cerebral Ventricles / Q000503:physiopathology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D013345:Subarachnoid Hemorrhage / Q000209:etiology*