Bilateral frontal haemorrhages associated with continuous spinal analgesia

We report a case of intracerebral haemorrhages associated with continuous s pinal analgesia. Continuous spinal analgesia is frequently employed for pos toperative analgesia in high-risk patients in our institution. The analgesi a is administered via a 20 gauge catheter passed through an 18 gauge Tuohy needle (Portex). A 71-year-old man with severe respiratory impairment had a n intrathecal catheter placed for postoperative analgesia. He had a difficu lt postoperative course, including wound dehiscence, and died from respirat ory failure some five weeks postoperatively. On day nine postoperatively he had two tonic-clonic seizures and was subsequently found to have developed bilateral frontal intracerebral haemorrhages. There was no previous histor y of seizures. Although several confounding variables exist, the most likel y explanation for the intracerebral event appears to be an association with the dural puncture and intrathecal catheter. Possible mechanisms and risk factors are discussed.