title: Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases.
abstract: BACKGROUND
  Intracranial subdural haematoma is a rare but serious complication of neuraxial anaesthesia. With early diagnosis and treatment, severe neurological sequelae can be avoided. A literature search of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients was performed. Based on the findings, a flow chart on how to assess postpartum headache following a neuraxial procedure is proposed.
  
  
  METHODS
  Medline, Embase and Cochrane databases were searched for cases of intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients. Epidemiological factors, clinical symptoms and signs, treatment, outcome and the effect of performing an epidural blood patch were assessed.
  
  
  RESULTS
  Review of the literature identified 56 cases following neuraxial procedures (epidural n=34, spinal n=20, combined spinal-epidural n=2). Predisposing risk factors were present in only a minority of patients. Persistent headache that stopped responding to postural change was the most important symptom with occurrence in 83% of patients. Focal neurological signs were present in 69% of women. Eleven percent of women were left with residual neurological deficits; the mortality rate was 7%.
  
  
  CONCLUSIONS
  Intracranial subdural haematoma following neuraxial anaesthesia in obstetric patients is rare but serious complications may result. Vigilance is required whenever a headache becomes non-postural, prolonged and/or whenever focal neurological signs occur.
authors.affiliation: Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium. Electronic address: virginie@colle-cuypers.be.
authors.forename: V
authors.initials: V
authors.lastname: Cuypers
authors.affiliation: Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Van de Velde
authors.affiliation: Department of Anaesthesiology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Devroe
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors
keywords: Intracranial subdural haematoma; Neuraxial block; Obstetrics