Anesth Pain Med.  2018 Apr;13(2):154-157. 10.17085/apm.2018.13.2.154.

Subarachnoid hematoma after spinal anesthesia: A case report

• Jang W
• Cho YH
• Lee DH
• Kim SH

• KMID: 2437421
• DOI: http://doi.org/10.17085/apm.2018.13.2.154

Abstract

Spinal subarachnoid hematoma is a very rare complication of spinal anesthesia. This complication can, and is, often overlooked and dismissed as a fatal neurological consequence of (what amounts to) delayed diagnosis. In this case, a 59-year-old female patient with no specific medical history underwent right knee arthroscopy under spinal anesthesia. The arthroscopic surgery concluded without complications but, on the first postoperative day, the patient complained of lower back pain, headache, nausea, vomiting. On the fifth postoperative day, magnetic resonance imaging was taken and it revealed evidence of a subarachnoid hematoma involving the L3 and L4 vertebral levels. Hematoma evacuation was performed, and the patient recovered without sequelae. Here, we report this case that lumbar spinal subarachnoid hematoma was found five days after spinal anesthesia which was done in a patient without coagulopathy.

Keyword

Spinal anesthesia; Spinal subarachnoid hematoma

MeSH Terms

Anesthesia, Spinal*
Arthroscopy
Delayed Diagnosis
Female
Headache
Hematoma*
Humans
Knee
Low Back Pain
Magnetic Resonance Imaging
Middle Aged
Nausea
Vomiting

Figure

• 

  Fig. 1 (A, B) Lumbar magnetic resonance imaging (T2 weighted image) showed heterogeneous signal intensity (arrows) at ventral to the spinal cord spreading from L3 to L4.

• 

  Fig. 2 Intraoperative photograph showed that dura mater (arrow) was exposed and its color was dark red. Cerebrospinal fluid was aspirated with 23 G needle and reddish fluid was aspirated.

• 

  Fig. 3 Intraoperative photograph showed that under the rootlets, there was clotted mass of hematoma (arrow).

• 

  Fig. 4 (A, B) Postoperative lumbar magnetic resonance imaging showed complete evacuation of the subarachnoid hematoma.

Reference

1. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev. 2003; 26:1–49. DOI: 10.1007/s10143-002-0224-y. PMID: 12520314.

2. Jeon SB, Ham TI, Kang MS, Shim HY, Park SL. Spinal subarachnoid hematoma after spinal anesthesia. Korean J Anesthesiol. 2013; 64:388–9. DOI: 10.4097/kjae.2013.64.4.388. PMID: 23646256. PMCID: PMC3640179.

3. Koyama S, Tomimatsu T, Kanagawa T, Sawada K, Tsutsui T, Kimura T, et al. Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome. Int J Obstet Anesth. 2010; 19:87–91. DOI: 10.1016/j.ijoa.2009.05.007. PMID: 19945267.

4. Domenicucci M, Ramieri A, Ciappetta P, Delfini R. Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature. J Neurosurg. 1999; 91(1 Suppl):65–73. DOI: 10.3171/spi.1999.91.1.0065.

5. Domenicucci M, Ramieri A, Paolini S, Russo N, Occhiogrosso G, Di Biasi C, et al. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochir (Wien). 2005; 147:741–50. DOI: 10.1007/s00701-004-0458-2. PMID: 15711890.

6. Lam DH. Subarachnoid haematoma after spinal anaesthesia mimicking transient radicular irritation: a case report and review. Anaesthesia. 2008; 63:423–7. DOI: 10.1111/j.1365-2044.2007.05368.x. PMID: 18336494.

7. Tjandra JJ, Varma TR, Weeks RD. Spinal arachnoiditis following subarachnoid haemorrhage. Aust N Z J Surg. 1989; 59:84–7. DOI: 10.1111/j.1445-2197.1989.tb01470.x. PMID: 2913997.

8. Bruce-Brand RA, Colleran GC, Broderick JM, Lui DF, Smith EM, Kavanagh EC, et al. Acute nontraumatic spinal intradural hematoma in a patient on warfarin. J Emerg Med. 2013; 45:695–7. DOI: 10.1016/j.jemermed.2013.04.048. PMID: 23988138.

9. Wang C, Ao Y, Fan X, Wang J, Cui G, Hu Y, et al. C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection. Arthroscopy. 2014; 30:1110–5. DOI: 10.1016/j.arthro.2014.03.025. PMID: 24863405.

10. Sather MD, Gibson MD, Treves JS. Spinal subarachnoid hematoma resulting from lumbar myelography. AJNR Am J Neuroradiol. 2007; 28:220–1. PMID: 17296983.

11. Avecillas-Chasín JM, Matias-Guiu JA, Gomez G, Saceda-Gutierrez J. A case of acute spinal intradural hematoma due to spinal anesthesia. J Aucte Dis. 2015; 4:341–3. DOI: 10.1016/j.joad.2015.06.015.