Lumbar subarachnoid hemorrhage in a parturient with HELLP Syndrome revealed by but unrelated to spinal anesthesia; A review of differential diagnosis of spinal subarachnoid hemorrhage in pregnancy

A 32 year old female with pre-eclampsia presented for cesarean delivery and was found to have leg weakness reported after spinal attempts. MRI revealed lumbosacral subdural and subarachnoid blood felt to be unrelated to the neuraxial anesthesia attempts. The main cause of spinal subarachnoid/subdural hemorrhage in pregnancy is generally a result of neuraxial anesthesia. However, in this case, the lower extremity symptoms preceded the spinal anesthesia attempts. The subarachnoid blood was felt to have an alternative etiology, prompting a thorough review of the differential diagnosis of subarachnoid hemorrhage in the parturient.