Subacute Intracranial Subdural Hematoma 40 Days After Spinal Anesthesia: A Case Report

Subdural hematoma is a serious but rare complication of spinal anesthesia. Differentiation between post-dural puncture headache (PDPH) and subdural hematoma can be difficult. A 32-year-old female patient underwent elective cesarean section under spinal anesthesia. Ten days postoperatively, the patient developed symptoms of headache and nausea, which progressed over time. The patient was brought to the emergency department on the 40th postoperative day with hemiparesis on the left side of the body. Brain MRI revealed a sub acute subdural hematoma. Progressive neurologic signs and evidence of mass effect and cerebral shifting on brain imaging were clear indications for surgical intervention. The patient recovered completely after surgical decompression. A high index of suspicion for the pattern and characteristics of headache, and a meticulous neurologic examination, can help the emergency physician recognize the serious entity of subdural hematoma.