title: [Life-threatening acute subdural haematoma after combinedspinal-epidural anaesthesia in labour].
abstract: OBJECTIVE
  Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal orepidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal-epidural anaesthesia used in labour.
  
  
  METHODS
  A 34-year-old, primigravid women with a gestation of 38 weeks underwent cae-sarean section under combined spinal-epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic-clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She under-went urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed anextradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal.
  
  
  CONCLUSIONS
  As conclusion, with the use of this combined spinal-epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur.
authors.affiliation: Departamento de Neurocirurgia, Faculdade de Medicina, Kirikkale University, Kirikkale, Turquia. Electronic address: bulentbanrs@yahoo.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Bakar
authors.affiliation: Departamento de Anestesiologia e Reanimação, Hospital Tobb-ETU, Ankara, Turquia.
authors.forename: Esra
authors.initials: E
authors.lastname: Ozer
authors.affiliation: Departamento de Neurocirurgia, Hospital Tobb-ETU, Ankara, Turquia.
authors.forename: Ismail Hakki
authors.initials: IH
authors.lastname: Tekkok
keywords: Anestesia combinada raquiperidural; Combined spinal‐epidural anaesthesia; Hematoma subdural; Labour; Parto; Subdural haematoma