Extensive spinal epidural hematoma as the cause of postpartum headache and neck pain after epidural anesthesia: a case-based report

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Tuiskunen-Bäck, AnneUmeå universitet,Institutionen för klinisk mikrobiologi (author)

Extensive spinal epidural hematoma as the cause of postpartum headache and neck pain after epidural anesthesia : a case-based report

Article/chapterEnglish2022

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2022-07-23
Springer Science and Business Media LLC,2022
electronicrdacarrier

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LIBRIS-ID:oai:DiVA.org:umu-201273
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-201273URI
https://doi.org/10.1007/s42399-022-01238-6DOI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

Notes

Spinal epidural hematomas (SEH) are a rare hemorrhagic event occurring after trauma, epidural anesthesia, or operative inventions. However, in 40–50% of cases, they occur spontaneously. Spontaneous spinal epidural hematomas (SSEH) are rare in occurrence with an estimated incidence of 1 case per million annually. Pregnancy is an independent risk factor. Sudden neck or back pain, often in combination with a rapid onset of neurological symptoms, is the most common presentation of SEH (1). A 36-year-old Caucasian female with rheumatoid arthritis (RA) presented to the emergency department approximately 48 h after an uncomplicated vaginal delivery. She sought medical attention due to constant headaches and neck pain that started during active labor. An MRI of the spine revealed an extensive SEH spreading from C1 to L5. The patient was without neurological symptoms or deficits and was successfully treated conservatively without any sequelae. Even though the definitive cause of this case of SEH will remain unknown, several possible synergistic mechanisms have been identified. These include female gender, full-term pregnancy, physical activity with increased intraabdominal pressure (i.e., Valsalva maneuver), systemic administration of platelet aggregation inhibitor (PAI), and iatrogenic manipulation such as spinal epidural anesthesia. Even though autoimmune and inflammatory disorders have been described in the literature to be rare sources of hemorrhage in the spinal canal, it is unclear whether the patient’s RA should be regarded as an individual risk factor.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Anestesi och intensivvård hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Anesthesiology and Intensive Care hsv//eng
Epidural hematoma
Pregnancy
Rheumatoid arthritis
Spinal epidural anesthesia

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Åkerstedt, JosefinUmeå universitet,Ortopedi(Swepub:umu)joak0027 (author)
Umeå universitetInstitutionen för klinisk mikrobiologi (creator_code:org_t)

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