title: Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature.
abstract: OBJECTIVE
  Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other 33 cases found on literature review.
  
  
  METHODS
  In 35 patients (ages 20-88 years, 19 males), 14 were older than 60 years (40%), of which 12 (86%) were males. The relationship is inverted in the group of younger patients (< 60 years), in which we observed twice as many women (14:7). Two peaks of higher incidence were observed: 30-39 years (31%) and 60-69 years (29%). The length of time from the beginning of symptoms until diagnosis ranged from 4 hours to 29 weeks. Headache was the main complaint in 26/35 (74.3%) patients; changes in the level of consciousness in 14/35 (40.0%); vomiting in 11/35 (31,4%); hemiplegia or hemiparesis in 8/35 (22.9%); diplopia or VI nerve paresis in 5/35 (14.3%); and language disorders in 4/35 (11.4%). Contributing factors included: pregnancy, multiple punctures, use of anticoagulants, intracranial vascular abnormalities, and brain atrophy. In 15 cases, a contributing factor was not mentioned. Four out of 35 patients (11.4%) remained with neurologic sequelae, and 4/35 (11.4%) died.
  
  
  CONCLUSIONS
  The presence of any of the signs or symptoms mentioned above should alert for the possibility of an intracranial subdural hematoma as a complication of puncture of the dura mater, especially in those patients with PDPH for more than one week, at which time investigation by neuroimaging is necessary.
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia of Hospitais da Restauração (HR), Getúlio Vargas (HGV), e Oswaldo Cruz (HOC), Recife-PE, Brazil. janemarcos22@superig.com.br
authors.forename: Jane Auxiliadora
authors.initials: JA
authors.lastname: Amorim
authors.forename: Diana Souza Canuto dos Anjos
authors.initials: DS
authors.lastname: Remígio
authors.forename: Otávio
authors.initials: O
authors.lastname: Damázio Filho
authors.forename: Marcos Aureliano Guerra
authors.initials: MA
authors.lastname: de Barros
authors.forename: Valentina Nicole
authors.initials: VN
authors.lastname: Carvalho
authors.forename: Marcelo Moraes
authors.initials: MM
authors.lastname: Valença
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult