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1/5. Intracranial subdural hematoma after spinal anesthesia.

    Intracranial subdural hematoma is an exceptionally rare but life-threatening complication of spinal anesthesia. We report a case of intracranial subdural hematoma following spinal anesthesia for cesarean section in a 27-year-old woman. She developed a diffuse headache after surgery with a blood pressure of 220/140 mm Hg which was followed by generalized seizure activity. Her blood pressure remained high after medication with diazepam, nifedipine and magnesium sulfate. She remained unconscious with a glasgow coma scale of 5. The cranial tomography revealed a subdural hematoma with diffuse cerebral edema and cerebral tentorial herniation. When a patient complains of postdural puncture headache and then has seizure activity, one should consider alternative diagnoses, including that of a subdural hematoma, and carry out a careful examination, including magnetic resonance imaging or computerized tomography scan.
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2/5. Intraspinal and intracranial hemorrhage after lumbar puncture.

    Two cases of spinal epidural hematoma and two cases of intracranial subdural hematoma after lumbar puncture (LP) are reported in children receiving chemotherapy for acute lymphoblastic leukemia and non-Hodgkin lymphoma. The bleeding was asymptomatic but interfered with treatment in one case, and caused either severe backache or headache but no neurological deficit in the other three patients. The platelet counts were 8 and 46 x 10(9)/L in two patients and were normal in the other patients at the time of LP. All recovered without surgical treatment. There is an inherent, albeit uncommon, risk of bleeding into the central nervous system associated with LP in children with cancer and should be distinguished from postdural puncture headache (PDPH). thrombocytopenia is not always an accompanying factor.
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3/5. Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.

    The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.
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4/5. Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery.

    STUDY DESIGN: Case report. OBJECTIVE: To report a case of an acute intracranial subdural hematoma that formed due to cerebrospinal fluid (CSF) leak following lumbar surgery. SUMMARY OF BACKGROUND DATA: intracranial hypotension may occur when CSF is removed from the subarachnoid space. Intracranial subdural hematoma formation has been observed following significant CSF drainage during lumbar puncture or ventricular shunt placement. However, formation has been described only twice in the literature following spine surgery. methods: Retrospective review of the patient's medical record and head CT imaging. RESULTS: A 55-year-old woman underwent lumbar surgery for failed back syndrome. Intraoperatively, a dural tear was noted and repaired. One week later, she developed expressive aphasia, and CSF drainage from her lumbar wound was noted. A head CT revealed an acute intracranial subdural hematoma with mass effect. Evacuation of the hematoma occurred via craniotomy, and the lumbar dura was repaired intraoperatively. CONCLUSIONS: We report the rare case of an acute intracranial subdural hematoma caused by a CSF leak following lumbar surgery. This report illustrates the potential morbidity associated with CSF leaks occurring after spinal surgery.
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5/5. Venous loop mimicking middle cerebral artery bifurcation aneurysm on computed tomographic angiography--case report.

    BACKGROUND: CT angiography has been widely used for the detection of cerebral aneurysm. However, there are still limitations despite improving CT angiographic techniques. We describe the unusual case of the detection of a false-positive aneurysm on CT angiography. CASE DESCRIPTION: A 64-year-old man presented with a 14-day history of severe headache and nuchal rigidity. brain CT demonstrated no subarachnoid hemorrhage, but cerebrospinal fluid appeared xanthochromic in 3 successive tubes after lumbar puncture. Subsequent CT angiography suggested an aneurysm at the bifurcation of the left MCA. However, at operation, prominent sylvian vein superimposed on the bifurcation of the left MCA, and there was no aneurysm. Follow-up monitoring with conventional angiography at 2 weeks showed no abnormal findings. The patient recovered uneventfully. CONCLUSION: The case demonstrates that although CT angiography has a reportedly high specificity and sensitivity for the detection of intracranial aneurysm, careful interpretation is required to diagnose intracranial aneurysms.
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