SPINAL SUBDURAL-HEMATOMA AS A COMPLICATION OF IMMEDIATE EPIDURAL BLOOD PATCH

Purpose: The authors report a case of a patient who developed spinal s ubdural haematoma after a series of epidural blood patches to alert an aesthetists to this rare complication. Clinical Features: The patient was a 35-yr-old woman without coagulopathy and was initially treated e lsewhere for chronic pain by repetitive epidural phenol injections. Wh en the dura was inadvertently punctured during subsequent attempts to inject phenol, immediate epidural blood patch was performed to treat o r prevent headache. The patient developed cauda equina syndrome after six epidural blood parches. The clinical diagnosis was confirmed by ma gnetic resonance imaging and the intradural haematoma was evacuated su rgically. The patient made a complete recovery. Conclusions: Epidural blood patch is not without complications. Transient backache and/or ra diculopathy may occur in up to one-third of patients receiving a blood patch. If signs and symptoms continue or worsen, a spinal subarachnoi d and/or subdural haematoma should be suspected and neurosurgical opin ion sought. The technique used to identify the epidural space is impor tant in preventing subdural injection of blood. The needle should be w ithdrawn after dural puncture and the epidural space identified at a d ifferent level. Blood patches may carry a higher risk of serious compl ications after multiple epidural phenol injections because of fibrosis and obliteration of the epidural space. Magnetic resonance scans reli ably demonstrate the extent of the pathology. If diagnosed and heated before irreversible changes occur, spinal intradural haematoma can res ult in complete recovery.