Fatal acute subdural hematoma after spinal anesthesia

Case report

Abstract

Post-spinal anesthesia headache is a complication with a prevalence that varies between 1/500,000 and 1/1,000,000 and its occurrence points to a pressure gradient between the intracranial subarachnoid and spinal spaces due to the presence of a dural injury caused by the puncture. The persistence of the barometric gradient, however, can determine greater separation of the cerebral surface from the dura mater, with rupture of the bridging veins and formation of acute subdural hematoma (aSDH), a condition associated with high morbidity and mortality. aSDH after spinal anesthesia is a rare and potentially fatal complication. In the literature, it is observed that the majority of aSDHs after dural puncture did not result in exuberant mass effects or major clinical changes, meaning that urgent surgical treatment was not necessary, with the institution of clinical treatment for subsequent surgical surgery in a hematoma already showing signs of urgency chronification. In this reported case, it is evident that a patient had a head CT upon admission within the normal age range, however, she developed neurological changes and a new imaging examination showed a large aSDH with great clinical repercussions, and in the evaluation by neurosurgery, she presented signs of brain death without the possibility of neurosurgical treatment due to the impossibility of reversing the condition or providing any benefit to the patient.