Spinal anesthesia for cesarean delivery resulting in postdural puncture headache and intracranial subdural hematoma − a case report

Background

Spinal anesthesia is routinely used for cesarean delivery. Intracranial subdural hematoma (SDH) is a potentially fatal complication of neuraxial anesthesia and is extremely uncommon. This report describes a case of SDH following uncomplicated spinal anesthesia for elective cesarean delivery and highlights the importance of timely intervention and patient follow-up.

Case

A 35-year-old patient with a history of hepatitis B underwent elective cesarean delivery under spinal anesthesia provided with a pencil-point 25G needle at the presumed L3-L4 interspace. She experienced a mild non-positional headache the next day managed with oral pain medications. After discharge, she presented twice for worsening headache symptoms. By the 12^th postpartum day, symptoms were suggestive of post-dural puncture headache, prompting imaging that revealed a left-sided subdural hematoma with mass effect. After multidisciplinary consultation with neurosurgery, an epidural blood patch (18 mL) was performed. Despite worsening radiological findings, the patient experienced symptomatic relief. The patient was discharged with follow-up arranged at the institution’s headache clinic.

Conclusion

While post-dural puncture headache after unintended dural puncture may be common, serious complications such as SDH are rare and require prompt diagnosis and intervention. This case illustrates a rare but serious complication of an uncomplicated spinal anesthesia, highlighting the need for thorough follow-up and prompt interventions. This report underscores the importance of revising discharge instructions after neuraxial anesthesia to include education on symptoms of post-dural puncture headache and the necessity of timely re-evaluation if symptoms worsen.