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1/3. Subdural haematoma after dural puncture headache treated by epidural blood patch.

    Subdural haematoma is a well-documented complication of accidental dural puncture, and is thought to be preventable by prompt treatment with an epidural blood patch. An accidental dural puncture occurred in a 39-yr-old primagravida during the siting of an epidural catheter for pain relief in labour. Twenty hours after the puncture, the mother developed a typical postdural puncture headache, which increased in severity over the subsequent 24 h. An epidural blood patch was performed at 48 h, and this initially relieved the headache. After discharge from hospital, and 14 days after the dural puncture, the headache recurred, together with expressive dysphasia, poor co-ordination and sensory loss in the right arm. A magnetic resonance imaging scan demonstrated a left sided subdural haematoma, which was drained successfully with complete recovery.
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2/3. Chronic subdural haematoma complicating spinal anaesthesia.

    Cranial subdural haematoma formation following spinal anaesthesia is exceptionally rare. A 38-year-old male developed headache two days after testicular surgery under spinal anaesthesia. The headache progressed in spite of analgesics, and three weeks later cranial CT showed a large chronic subdural haematoma in the left fronto-parietal region. The patient improved after surgical decompression. The pathogenesis of subdural haematoma formation after dural puncture is discussed and the literature briefly reviewed. Prolonged and severe post-dural puncture headache should be viewed with suspicion and investigated promptly to rule out any intracranial complication.
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3/3. Persistent postpartum headache from a chronic subdural hematoma after peridural anesthesia.

    BACKGROUND: Postpartum headache after peridural anesthesia is usually attributed to accidental perforation of the dura causing postlumbar puncture headache. CASE: In a patient with persistent headache after peridural anesthesia for labor, a chronic subdural hematoma was diagnosed 5 weeks postpartum. CONCLUSION: Caution is warranted in patients with peridural anesthesia for labor who present with unusually persistent headache.
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