Fatal Acute Intracranial Subdural Hematoma After Spinal Anesthesia for Cesarean Delivery: Case Report and Review of the Literature

The authors report on the autopsy case of a 40-year-old primigravida without either coagulation disorders or anticoagulant/antiplatelet therapy, who developed a fatal intracranial subdural hematoma after spinal anesthesia (SA) for elective cesarean delivery for tocophobia. Intracranial subdural hematoma is the most dreaded complication of SA and is often misdiagnosed with postdural puncture headache. In this article, the authors discuss pathophysiological mechanisms and risk factors for the development of an intracranial subdural hematoma after SA and review the pertinent literature.
Source: The American Journal of Forensic Medicine and Pathology - Category: Forensic Medicine Tags: Original Articles Source Type: research

Related Links:

Publication date: Available online 30 November 2019Source: Journal of EthnopharmacologyAuthor(s): Ya min Luo, Xiao qiao Ren, Xue qin Yang, Hui rong Song, Ran Li, Ming hui Gao, Yi ran Li, Ran ran Zhou, Lei Ma, Shu jing Zhang, Ruan juan Dong, Dong yu Ge, Chun guo Wang, Qing jia Ren, Xiao hua TaoAbstractEthnopharmacological relevanceMigraine is a disabling neurovascular disorder, which increases risk of cardiovascular events and is a social burden worldwide. The present first-line anti-migraine medications can cause overwhelming side-effects, of which one includes the onset of cardiovascular disease. As one of the marketed Ti...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
The most common complication of neuraxial labor analgesia,1 accidental dural puncture (ADP), causes headache, nausea, neck stiffness, diplopia and tinnitus, all of which are attributed to leakage of cerebrospinal fluid (CSF) from the intrathecal space.2 The resultant intracranial hypotension has been shown on magnetic resonance imaging (MRI) to be associated with downward movement of intracranial structures, meningeal enhancement and vasodilation of blood vessels.3 Although positional headache is the most common symptom of ADP, other symptoms of intracranial hypotension may be more prominent or may present on their own.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
We read with interest the recent Obstetric Anaesthetists Association (OAA) guidelines pertaining to the diagnosis and management of post-dural puncture headache (PDPH).1 The OAA guideline states “a volume of blood of 20 mL is recommended when performing an epidural blood patch (EBP) and injection should stop before 20 mL if not tolerated by the patient”. This statement gives the impression that 20 mL represents an optimum endpoint for injecting blood during EBP. Our local practice is to use patient symptoms (back discomfort) as the endpoint and hence we often exceed a volume of 20 mL.
Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Publication date: Available online 27 November 2019Source: NeuroscienceAuthor(s): Antonina Dolgorukova, Anastasiia V. Osipchuk, Anna A. Murzina, Alexey Y. SokolovAbstractMetoclopramide widely used as an abortive migraine therapy due to the advantage of having not only antiemetic, but also analgesic properties. Despite the proven clinical efficacy of metoclopramide in acute migraine, the mechanism of its anti-cephalalgic action has not been entirely elucidated. Taking into account the key role of the trigeminovascular system activation in migraine pathophysiology, we aimed to investigate metoclopramide effects on the excita...
Source: Neuroscience - Category: Neuroscience Source Type: research
(Anesth Analg. 2019;129(1):155–161) For cesarean deliveries, spinal anesthesia is typically performed with the use of manual palpation. However, some patients present challenges to this method, particularly patients with imperceptible surface landmarks or those who are obese. Because spinal anesthesia placement may be more difficult in these patients, there is an increased likelihood of postdural puncture headache, paresthesia, or spinal hematoma. It has been proposed that preprocedure ultrasound scanning can assist care providers with spinal anesthesia placement, but not much research has been done on this subject....
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Anesthesia Source Type: research
(Int J Obstet Anesth. 2019;37:52–56) In patients with Arnold Chiari malformations (ACM) the cerebellum herniates through the foramen magnum and displaces the lower pons and medulla. In addition, the flow of cerebrospinal fluid from the fourth ventricle is impaired, and dynamic or static herniation of brain tissue can occur. In ∼25% of patients with ACM, the pressure gradient generated by this condition can lead to the development of a syringomyelia, which is an abnormal cavitation within the spinal cord. Type 1 Arnold Chiari malformations (ACM-1) is the most common of 4 categories of ACM, and women with ACM-I ar...
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research
DiscussionThe incidence of ADP at our hospital (0.78%) is within the range quoted in the literature (0.1 –1.5%) and below the UK standard of 1%. The incidence of PDPH after recognized ADP (68%) is also consistent with other published reports.
Source: Irish Journal of Medical Science - Category: General Medicine Source Type: research
Source: Journal of Pain Research - Category: Anesthesiology Tags: Journal of Pain Research Source Type: research
Conclusions: Spinal anesthesia with a median or paramedian approach at cesarean section has no effect on the incidence of PDPH, but we believe that there has been a need for further studies with larger or different patient populations.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
ConclusionsThe management of patients with NORSE remains challenging, often requiring multiple intravenous anaesthetic treatments, leading to complicated and prolonged hospital and intensive care unit stays but good outcome remains possible.
Source: Seizure - Category: Neurology Source Type: research
More News: Anesthesia | Anesthesiology | Forensic Medicine | Headache | Migraine | Pathology