title: [Cranial subdural hematoma with intracranial hypotension related to epidural anesthesia and Trendelenburg position: a case report].
abstract: We report a case of cranial subdural hematoma with intracranial hypotension. A 34-year-old woman had laparoscopic ovarial cysterectomy under general anesthesia combined with epidural anesthesia. Two days later, she developed a severe headache and nausea. She underwent cranial magnetic resonance imaging (MRI) scanning, and was diagnosed with cranial subdural hematoma with intracranial hypotension. The patient had had no anticoagulant therapy before the surgery. She was managed conservatively with bed rest and additional intravenous infusion. Her symptoms gradually improved except a slight headache, and she was discharged on the 38th postoperative day. Intracranial hypotension is a syndrome characterized by orthostatic headaches and hypovolemia of cerebrospinal fluid (CSF). There were typical findings on MRI, which include linear enhancement of the pachymeninges, pituitary hyperemia and subdural hemorrhage. We thought that these were due to epidural anesthesia first, but there was no evidence of dural puncture. It was also considered that it is influenced by change in CSF pressure, and intracranial venous engorgement may be due to Trendelenburg position for several hours. Because cranial subdural hematoma is a life-threatening complication, it is necessary to reconsider application of epidural anesthesia for laparoscopic surgery with Trendelenburg position.
authors.affiliation: Department of Anesthesiology, Yamagata University School of Medicine, Yamagata 990-9585.
authors.forename: Ayuka
authors.initials: A
authors.lastname: Narisawa
authors.forename: Shinya
authors.initials: S
authors.lastname: Oda
authors.forename: Kazue
authors.initials: K
authors.lastname: Iizawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Yokoo
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakane
authors.forename: Kaneyuki
authors.initials: K
authors.lastname: Kawamae
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General; D005260:Female; D018475:Head-Down Tilt / Q000009:adverse effects*; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology* / Q000628:therapy; D006801:Humans; D019585:Intracranial Hypotension / Q000209:etiology* / Q000628:therapy; D010535:Laparoscopy; D010048:Ovarian Cysts / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy