Acute subdural hematoma after dural puncture

Soto Garrucho, E.; San Antonio Gil, Á.; Martín González-Haba, M.P.; Echevarría Moreno, M.

doi:10.1016/j.redare.2021.07.006

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Acute right subdural haematoma with a maximum thickness of 13mm (arrow) causing significant mass effect with midline shift and signs of incipient transtentorial herniation." ] ] ] "textoCompleto" => "Our patient was a 64-year-old man with no known drug allergies. His personal history was significant for benign prostatic hypertrophy treated 10 days prior by transurethral prostatectomy under subarachnoid anaesthesia using a 24G Sprotte needle to perform a single, medial, atraumatic puncture. Anaesthesia was uneventful.Forty-eight hours after the intervention, he reported frontal and occipital, non-pulsatile, orthostatic headache. This was diagnosed as post-dural puncture headache, and the patients was discharged with analgesic treatment. After 10 days, he presented in the Emergency Department with a predominantly temporal, intense, throbbing, continuous headache with mild episodes of disorientation that did not subside with NSAIDs or pyrazolones. A neurological examination was normal. We decided to perform a CT without contrast, which showed an acute right subdural haematoma with mass effect, midline shift, and incipient transtentorial herniation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). An angio-CT of the supra-aortic trunks ruled out dural/pial arteriovenous fistula. He was diagnosed with acute post-dural puncture subdural haematoma, an uncommon complication caused by traction and subsequent bleeding of the meningeal vessels due to cerebrospinal fluid hypotension. Dexamethasone 8mg was administered and the patients was transferred by intensive care ambulance to a referral centre for decompressive craniectomy.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>FundingThis study did not receive any financial support." 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ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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