Yonsei Med J.  2010 May;51(3):475-477. 10.3349/ymj.2010.51.3.475.

Subarachnoid and Intraventricular Hemorrhage due to Ruptured Aneurysm after Combined Spinal-Epidural Anesthesia

• Chun DH
• Kim NY
• Shin YS

• KMID: 1075008
• DOI: http://doi.org/10.3349/ymj.2010.51.3.475

Abstract

A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm.

Keyword

Aneurysm rupture; spinal anesthesia; subarachnoid hemorrhage

MeSH Terms

Aged
Anesthesia, Epidural/*adverse effects
Anesthesia, Spinal/*adverse effects
Aneurysm, Ruptured/*chemically induced/*complications
Cerebral Ventricles/*physiopathology
Humans
Intracranial Hemorrhages/*etiology
Male
Subarachnoid Hemorrhage/*etiology

Figure

• 

  Fig. 1 CT scan of a brain showing a large amount of subarachnoid hemorrhage and intraventricular hemorrhage.

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  Fig. 2 Brain CT angiogram showing a 6-mm aneurysm with a dauter sac at the anterior communicating cerebral artery and a 4-mm unruptured cerebral aneurysm at the left middle cerebral artery bifurcation. A large amount of subarachnoid hemorrhage and intraventricular hemorrhage is present.

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  Fig. 3 (A) Three-dimensional imaging of a catheter angiogram showing about a 5×4 mm saccular aneurysm at the anterior communicating artery. (B) Three-dimensional imaging of a catheter angiogram showing a 4×4 mm saccular aneurysm at the left middle cerebral artery.

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