Spinal Subarachnoid Hematoma after Spinal Anesthesia: A Case Report

ABSTRACT

STUDY DESIGN: Case report. OBJECTIVES: We report a case of spinal subarachnoid hematoma that developed after spinal anesthesia in a female patient who had no risk factors. SUMMARY OF LITERATURE REVIEW: Few case reports of spinal subarachnoid hematoma (SSH) after spinal anesthesia have been published. The incidence of SSH is much less than that of epidural hematoma. MATERIALS AND METHODS: A 56-year-old female patient underwent arthroscopic surgery on her right knee under spinal anesthesia. Automated patient-controlled analgesia (PCA) was applied after surgery. On day 2, the patient complained of lower back pain, headache, nausea, and vomiting, but there were no neurological signs in the lower extremity. At day 5, she had a moderate fever (38.4°) and continuous nausea and vomiting. Magnetic resonance imaging (MRI) was conducted on day 5 and a large subarachnoid hematoma was found. We immediately performed surgical hematoma evacuation. Her low back and buttock pain improved immediately, and all symptoms disappeared in a week without any neurological sequelae. RESULTS: The unusual and vague symptoms in this case made the diagnosis difficult, but spinal MRI confirmed SSH. Immediate surgical hematoma evacuation improved all symptoms and left no neurologic sequelae. CONCLUSIONS: SSH after spinal anesthesia may have cerebral symptoms that mimic the side effects of PCA. Early diagnosis by MRI and surgical evacuation of the SSH are a reasonable approach for this complication.