Intracranial Subdural Hygroma: A Rare Complication of Failed Neuraxial Anesthesia?

Abstract

The unintentional puncture of the dura during epidural procedures is a noteworthy and prevalent complication in obstetric patients. Early recognition can be difficult, particularly when attempts at neuraxial anesthesia are unsuccessful. Rare intracranial complications, such as subdural hematomas and subdural hygromas, can occur after dural puncture and they should be suspected in the presence of atypical headaches or other neurological symptoms. We describe a case of a woman who had an unrecognized dural puncture following failed neuraxial anesthesia and later presented with symptoms of intracranial hypotension. Urgent investigation with cranial CT scan revealed two intracranial subdural hygromas. We discuss the diagnosis, follow-up, and successful management of this case with an epidural blood patch. It is crucial to maintain a high level of suspicion for complications after neuraxial anesthesia and to have a low threshold for imaging and investigation to prevent unfavorable or fatal consequences.

Keywords: dural puncture; hygroma; neuraxial anesthesia; neuraxial anesthesia complications; obstetric anesthesia; post dural puncture headache; subdural hygroma.

Figure 1. Cranial CT showing (a) parasagittal parietal and (b) frontoparietal hygromas (black arrows).

Figure 2. Follow-up cranial CT showing partial resolution of the parasagittal parietal and frontoparietal hygromas.