title: Bilateral subdural hematoma secondary to accidental dural puncture.
abstract: We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain. Electronic address: sofiramirez@gmail.com.
authors.forename: Sofía
authors.initials: S
authors.lastname: Ramírez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gredilla
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Martínez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D017217:Blood Patch, Epidural / Q000379:methods; D005260:Female; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy; D059906:Neuroimaging / Q000379:methods; D051299:Post-Dural Puncture Headache / Q000209:etiology / Q000628:therapy; D011247:Pregnancy
keywords: Accidental dural puncture; Analgesia epidural; Cefaleia pós-punção dural; Dura-Máter; Epidural analgesia; Epidural blood patch; Hematoma subdural; Placa de sangue epidural; Post-dural puncture headache; Subdural hematoma