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Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome

[Hématome sous-dural intracrânien post-ponction durale chez une parturiente atteinte du syndrome HELLP]

Tiberiu Ezri, MD^*, Ezzat Abouleish, MD, Charles Lee, MD and Shmuel Evron, MD^*

^* From the Departments of Anesthesiology, Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel-Aviv University, Israel; and
the University of Texas Medical School, Houston, Texas, USA.

Dr. Tiberiu Ezri, Department of Anesthesiology, the Edith Wolfson Medical Center, Holon – Israel. Phone: 972 3 5028 229; Fax: 972 3 5028 228; E-mail: etb{at}netvision.net.il

Purpose: To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour.

Clinical features: This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000•µL^-1) who subsequently developed the syndrome of hemolysis, elevated liver enzymes and low platelets. On the first postoperative day, postdural puncture headache (PDPH) developed. An epidural blood patch (EBP) was deferred to the third postoperative day because of a platelet count of 21,000•µL^-1. However, the headache intensified from a typical PDPH to one which was not posturally related. A second EBP was abandoned after the injection of 5 mL of blood because of increasing headache during the procedure. Magnetic resonance imaging revealed bilateral temporal subdural hematomas. The patient was managed conservatively and discharged home without any sequelae.

Conclusion: It is conceivable that thrombocytopenia together with possible abnormal platelet function increased the risk of subdural hematoma. Alternative diagnoses to PDPH should be considered whenever headache is not posturally related.