Characteristics of Intracranial Subdural Hematomas Following Spinal and Epidural Anesthesia in Obstetric Patients

Background: Intracranial subdural hematomas (SDH) are quite rare complications of spinal anesthesia and epidural analgesia (SA/EA). Characteristics of the incident in obstetric patients were investigated. Methods: The PUBMED database was searched for three sets of key words: "subdural hematoma and spinal anesthesia", "subdural hematoma and epidural analgesia", " pregnancy and subdural hematoma and epidural anesthesia". The literature findings and our clinic series was reported. Results: The study reached at 26 obstetric cases between the age of 17 and 46 years (mean: 30.7 years). The majority of the patients (65.3%) were giving their first children. There were (34.7%) acute, (23%) sub-acute and (42.3%) chronic cases. Bilateral SDH was seen in 50% of epidural, 30.7% of the total cases. Patients, giving vaginal delivery, were more prone to have acute and sub-acute hematomas (61.5%), compared to Cesarean Section (CS) (53.8%). The mean duration of diagnosis was 379 hours. Patients managed conservatively in 42.3% of the cases. 3/9 of acute cases could be treated conservatively. Patients had favorable outcomes in 88.4%. Conclusions: Delayed diagnosis incurring patients at risk and high level of suspicion and vigilance were needed particularly in patients with headache lasting more than 5 days or nonpostural in character, associated with neurological findings.