Postpartum headache resulting from bilateral chronic subdural hematoma after dural puncture

Electron microscopic data on human bridging veins show thin walls of variable thickness, circumferential arrangement of collagen fibers, and a lack of outer reinforcement by arachnoid trabecules, all contributory to the subdural portion of the vein being more fragile than its subarachnoid portion.5...

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Bibliographic Details
Published in:The American journal of emergency medicine 2004-05, Vol.22 (3), p.241-242
Main Authors: Nolte, C.H, Lehmann, T.-N
Format: Article
Language:English
Subjects:
Adult
Analgesia, Epidural - adverse effects
Analgesia, Obstetrical - adverse effects
Anesthesia
Childbirth & labor
Diagnosis, Differential
Dura Mater - injuries
Emergency medical care
Evacuations & rescues
Female
Fibers
Headache - diagnosis
Headache - etiology
Headaches
Hematoma, Subdural, Chronic - diagnosis
Hematoma, Subdural, Chronic - etiology
Humans
Pain
Puerperal Disorders - diagnosis
Puerperal Disorders - etiology
Spinal Puncture - adverse effects
Tomography, X-Ray Computed
Veins & arteries
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Summary:Electron microscopic data on human bridging veins show thin walls of variable thickness, circumferential arrangement of collagen fibers, and a lack of outer reinforcement by arachnoid trabecules, all contributory to the subdural portion of the vein being more fragile than its subarachnoid portion.5 This fragility might lead to rupture by traction and tearing in the instant of a head trauma. The symptoms could subside after surgical decompression, but permanent neurologic deficits have been reported in old patients and when the hematoma was evacuated only after a long period of time.1 In summary, this report highlights the importance of considering a cSDH as differential diagnosis of headache as a rare but serious complication of epidural anesthesia, especially in connection with dural puncture and straining during labor.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2004.02.032