Fatal, Acute Subdural Hematoma Following Spinal Anesthesia In A Postpartum Patient: A Case Report With A Mini Literature Review

The authors report a case of fatal postpartum acute subdural hematoma after multiple attempts at spinal anesthesia related to cesarean delivery. A 22-year-old primigravida was admitted to the Obstetrics and Gynecology Department due to the throes of childbirth. The presence of threatening intrauterine hypoxia indicated a C-section with the usual lumbar anesthesia. However, the anesthesia proved insufficient, necessitating the administration of intratracheal narcosis, which occurred without complication. A healthy, mature boy was born with Apgar scores of 10/1 and 10/5. During the first 8 h of the postpartum period, the primipara exhibited stable vital parameters without neurological symptoms. After 8.5 h, a grand mal seizure was observed following a period of consciousness and spontaneous breathing that soon ceased. The CT scan examination revealed a significant left fronto-temporo-parietal acute subdural hematoma. All brainstem reflexes were absent, lacking corneal, trigemino-facial, and oculo-vestibular reflexes, with submaximal dilated pupils, and unresponsive to direct and consensual light stimuli. Despite an urgent neurosurgery operation and 4 days of intensive therapy, follow-up brain CT examinations showed a massive midline shift and compression of the supratentorial ventricle system. No trauma or other malformations of the brain were detected. According to the primary brain damage protocol, after a 12-hour observation period, brain death was declared, and she was deemed suitable for organ donation. Our mini-review identified 12 published cases of postpartum subdural hematoma following spinal anesthesia between 1995 and 2021. The data highlight the importance of early neuroimaging and multidisciplinary assessment when postpartum headaches or seizures occur.