Ferdi DOĞANAY, Lütfye PİRBUDAK, Rauf GÜL, MEHMET ALPTEKİN, Nurgül KAPLAN

Postspinal subakut subdural hematom: Olgu sunumu

Spinal anestezi sonrası gelişen intrakraniyal subdural hematom, nadir görülen ve tedavi edilmediğinde öldürücü olabilen ciddi bir komplikasyondur. Ponksiyon sırasında dural zedelenme nedeniyle devam eden beyin omurilik sıvısı (BOS) sızıntısı, meningiyal damarlarda gerilme ve yırtılma ile kanamaya yol açmaktadır. Yirmi dört yaşında, ASA I fziksel grupta, anamnez ve laboratuvar incelemelerinde bir özellik olmayan olguya L 4-5 aralığından 25 G Quincke iğne kullanılarak 12.5 mg heavy bupivakain ile tek seferde spinal anestezi yapıldığı, olgunun post spinal birinci gün başağrısının başladığı, başvurduğu dış merkezde post spinal baş ağrısı tanısı ile konservatif tedavi başlandığı öğrenildi. Hastanın başağrısının devam etmesi üzerine ağrı polikliniğimize sevk edilmişti. Hastanın anamnezinde başağrısının postural olmaması ve sol kulak arkasında olması, tek tarafı kulak çınlamasının olası nedeniyle hastaya acil kranyal bilgisayarlı tomograf çekilerek akut fronto-tempora-paryetal subdural hematom tanısı konuldu. Spinal anestezi sonrası, devam eden atipik başağrısı ve tinnitus varlığında subdural hematom olabileceği düşünülerek, anamnez, nörolojik muayene ve radyolojik görüntüleme yöntemleri ile erken tanı konabilir.

Postspinal subacut subdural hematoma: Case report

Te development of intracranial subdural hematoma after spinal anesthesia is a rare and serious complication that can be fatal if untreated. Needle puncture to the dura mater can cause leakage of cerebrospinal fuid, and lead to stretching and rupture of the men- ingeal blood vessels with resultant bleeding. A 24-year-old patient, with a completely normal history and laboratory analysis, has got a L4-5 level spinal anesthesia well done at frst try, using a Quinke 25 G needle and 12,5 mg bupivacaine heavy. Te frst day after spinal anesthesia, the patient started to have a headache. He applied to another hospital where he received conservative treatment with a diagnosis of post-spinal headache. But, persistence of the headache made the patient refer to our pain clinic. Te headache was located behind the left ear non-postural in nature, and was associated with tinnitus. Emergency cranial computerized tomography was obtained and acute fronto-temporo-parietal subdural hematoma was reported. After spinal anesthesia, continued atypical headache and presence of tinnitus must alert against an underlying subdural hematoma. Early diagnosis can be made by history of the patient combined with neurological and radiological imaging methods.

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