[Intracranial subdural hematoma following dural puncture].

BACKGROUND

Intracranial subdural hematoma (SDH) following dural puncture (DP) is a life-threatening complication. However, the characteristics and prognosis are little-known.

METHODS

Reports documenting intracranial SDH following DP were surveyed by using PubMed and the Igaku-chuou-zassi (Japana Centra Reveuo Medicina) database (1979-2005) and the cases were analyzed to clarify their characteristics and prognoses.

RESULTS

Sixty-nine case reports were enrolled. Seventy per cent of patients underwent anesthetic procedures including spinal and epidural anesthesia. Fifty-two per cent of patients, many of whom receiving obstetrical procedures, were under 40 years of age and majority of the rest of over 40 years were male. Eighty per cent of patients had an onset of SDH within 1 month after DP. Patients often showed disappearance of postural headache, associated with various neurological symptoms such as consciousness disorder, vomiting, hemiplegia and diplopia. The eighty-three per cent of patients recovered completely from SDH except 11 patients who died or afflicted with sequelae because of delayed diagnosis.

CONCLUSIONS

Seventy per cent of SDH occured following anesthesia related procedures. Most of them had an onset within one month after DP The prognosis was relatively good as long as SDH could be diagnosed at its early stage. It was necessary to observe the disappearance of postural headache and associated symptoms carefully to avoid delayed diagnosis.