Cervical Spinal Epidural Hematoma After Spinal Anesthesia for Cesarean Section in the Parturient Using Long-Term Low Dose Aspirin

Abstract

Spinal epidural hematoma (SEDH) is a rare but serious complication associated with spinal anesthesia (SA). We present an unusual case of cervical SEDH occurring 24 h after a lumbar puncture for a cesarean section. The patient, who was on low-dose aspirin due to preeclampsia, initially exhibited neurological symptoms resembling a stroke. Despite a normal magnetic resonance imaging (MRI) of the brain, further investigations revealed a SEDH located between the C3 and T1 segments, well beyond the L3-L4 puncture site. Although coagulation tests were normal, this case underscores the potential risk of low-dose aspirin in affecting platelet function, which may contribute to SEDH development. It also emphasizes the importance of considering spinal MRI when neurological symptoms arise after SA, even if initial cranial MRI results are normal. She underwent emergency C3-T1 laminectomy through a dorsal midline approach. Her motor, sensory, and sphincter functions fully recovered at follow-up.

Keywords: cervical spinal epidural hematoma; low-dose aspirin; surgical intervention.

Figure 1

(a) Postoperative T2–weighted sagittal image showing evidence of epidural hematoma in the C3-T1 segment (marked with an arrow); (b) postoperative T2–weighted axial image showing evidence of epidural hematoma (marked with an arrow).