Abstract
We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26–36) but all other tests of coagulation were normal. Epidural anaesthesia was attempted but, despite a negative test dose, injection of local anaesthetic resulted in a generalized seizure and general anaesthesia was induced. Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.
Résumé
Nous rapportons un cas d’hématome sous-dural rachidien avec déficit neurologique chez une femme de 36 ans, après une césa-rienne pour éclampsie sévère et décollement prématuré d’un placenta normalement inséré. La patiente suivait un traitement de longue durée à la trifluopérazine pour dépression. Son temps de céphaline activé (aPTT) est de 49 sec (N = 26–36) mais tous les autres tests de coagulation sont normaux. Une anesthésie épidurale mise en marche mais, malgré une dose-test négative, l’injection de l’anesthésique local provoque une crise convulsive. Une anesthésie générale est réalisée. Soixante-douze heures après la naissance on constate une faiblesse bilatérale des jambes, une incontinence urinaire, une absence du tonus du sphincter anal et des réflexes asymétriques aux membres inférieurs. Le diagnostic d’hématome sous-dural rachidien est confirmé par le cliché de résonnance magnétique nucléaire. Elle subit une laminectomie en urgence, suivie d’une récupération neurologique complète.
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Lao, T.T., Halpern, S.H., MacDonald, D. et al. Spinal subdural haematoma in a parturient after attempted epidural anaesthesia. Can J Anaesth 40, 340–345 (1993). https://doi.org/10.1007/BF03009633
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DOI: https://doi.org/10.1007/BF03009633