RESUMO
Intracranial hematoma after spinal anesthesia is a rare complication. It generally presents with posture-dependent headache that becomes persistent. We describe the case of patient submitted to spinal anesthesia for cesarean section who presented a non-posture-dependent headache, resistant to clinical treatment, that progressively worsened and with symptoms of intracranial hypertension. The patient had a history of head trauma without symptoms. The CT-scan revealed a chronic bilateral parietal hematoma with a recent bleeding component, treated surgically. We concluded that spinal puncture led to chronic hematoma to rebleed. We have reported the case to draw attention to the importance of investigating atypical headache after spinal anesthesia.
Assuntos
Raquianestesia , Hematoma Subdural Crônico , Hematoma Subdural Intracraniano , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Feminino , Cefaleia , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/etiologia , Humanos , GravidezRESUMO
Spinal anesthesia is a technique commonly used for local anesthesia and in obstetric surgeries. Rarely, the formation of an intracranial subdural hematoma (SDH) may result from spinal anesthesia, constituting a serious condition that often leads to severe neurological deficits. The presentation and course of this pathology may occur in a completely different way, which makes its diagnosis and management difficult. In the present article, the authors report two cases of patients with intracranial SDH after spinal anesthesia with completely different presentations and outcomes, demonstrating the variability of the manifestations of this condition. A quick review of key points of its pathophysiology, symptomatology, diagnosis, and treatment was also performed.
Assuntos
Humanos , Feminino , Adulto , Hematoma Subdural Intracraniano/cirurgia , Hematoma Subdural Intracraniano/fisiopatologia , Hematoma Subdural Intracraniano/tratamento farmacológico , Hematoma Subdural Intracraniano/diagnóstico por imagem , Raquianestesia/efeitos adversos , Raquianestesia/métodosRESUMO
Spontaneous intracranial hypotension (SIH) is a syndrome that was unknown until the advent of magnetic resonance imaging (MRI). It is a cause of orthostatic headache, which remains underdiagnosed and, rarely, can result in several complications including dural venous sinus thrombosis, subdural hematoma and subarachnoid hemorrhage. Some of these complications are potentially life-threatening and should be recognized promptly, mainly by imaging studies. We reviewed the MRI of nine patients with SIH and describe the complications observed in three of these patients. Two of them had subdural hematoma and one had a dural venous sinus thrombosis detected by computed tomography and MRI. We concluded that MRI findings are of great importance in the diagnosis of SIH and its complications, which often influence the clinical-surgical treatment of the patient.
Assuntos
Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico por imagem , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Cefaleia/etiologia , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/etiologiaRESUMO
ABSTRACT Spontaneous intracranial hypotension (SIH) is a syndrome that was unknown until the advent of magnetic resonance imaging (MRI). It is a cause of orthostatic headache, which remains underdiagnosed and, rarely, can result in several complications including dural venous sinus thrombosis, subdural hematoma and subarachnoid hemorrhage. Some of these complications are potentially life-threatening and should be recognized promptly, mainly by imaging studies. We reviewed the MRI of nine patients with SIH and describe the complications observed in three of these patients. Two of them had subdural hematoma and one had a dural venous sinus thrombosis detected by computed tomography and MRI. We concluded that MRI findings are of great importance in the diagnosis of SIH and its complications, which often influence the clinical-surgical treatment of the patient.
RESUMO Hipotensão Intracraniana Espontânea (HIE) é uma síndrome desconhecida até o advento das imagens de Ressonância Magnética (RM). É uma causa de cefaleia ortostática que permanece subdiagnosticada e raramente resulta em complicações, como trombose de seios venosos durais, hematoma subdural e hemorragia subaracnoidea. Algumas dessas complicações são potencialmente ameaçadoras à vida e devem ser prontamente reconhecidas pelos estudos de imagem. Nós revisamos as RM de 9 pacientes com HIE e descrevemos as complicações observadas em 3 casos. Dois deles tiveram hematoma subdural e um teve trombose de seio venoso dural detectados por tomografia computadorizada e RM. Concluímos que achados de RM são de grande importância no diagnóstico de HIE e suas complicações, frequentemente influenciando o tratamento clínico-cirúrgico do paciente.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico por imagem , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/diagnóstico por imagem , Hematoma Subdural Intracraniano/etiologia , Hematoma Subdural Intracraniano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Cefaleia/etiologiaAssuntos
Hematoma Subdural Intracraniano/diagnóstico por imagem , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Hematoma Subdural Intracraniano/patologia , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Ventricular over-drainage is a common complication of dysfunctional ventriculoperitoneal devices. Subdural haematomas are usually the most common lesions associated with that complication. Such lesions may arise after ventricular collapse and bridging veins disruption that follows over-drainage, thus contributing to distortion of brain parenchyma, increased intracranial hypertension and neurological decline. More rarely, extradural haematomas may also be observed after ventricular shunt hyperfunction and may result in rapid neurological decline unless a surgical procedure can be promptly performed. CASE: This study reports the case of a 38-old-woman who presented supratentorial hydrocephalus and developed bilateral extradural haematomas after the placement of a ventricular shunt device. Both haematomas were surgically approached and the dysfunctional shunt device was replaced. CONCLUSION: Extradural haematomas may develop precociously after ventricular over-drainage. Surgical treatment is mandatory and must include not only the evacuation of haematoma, but also the replacement of dysfunctional shunt to prevent further recurrence. The pathophysiology of extradural haematomas consequent of ventricular over-drainage and the possible use of a programmable valve to prevent these lesions are briefly discussed.
Assuntos
Drenagem/efeitos adversos , Hematoma Subdural Intracraniano/etiologia , Hematoma Subdural Intracraniano/cirurgia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Remoção de Dispositivo , Feminino , Hematoma Subdural Intracraniano/diagnóstico por imagem , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
There is no clear role for decompressive craniotomy (DC) for the intracranial hypertension (ICH) treatment in the literature. Actually, there is a lack of class I or II published data for DC, so it is recomended as a second tier option for the refractory ICH. Recent studies has analized the role of early DC for pos traumatic ICH. The present study analizes 21 patients who has received the early DC for the treatment of traumatic ICH. The majority of the patients had Glasgow Coma Scale < 9 and harboring a brain swelling or acute subdural hematoma at cranial computadorized tomography. Hydrocephalus was frequent after DC (28.5%). Good results were obtained in 11 patients (52.5%). We favour the early application of DC for pos traumatic hypertension.