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OBSTETRIC ANESTHESIA

The Diagnosis and Treatment of a Patient with Puerperal Infection and Subdural Hygromas

Natàlia Aragonès, MD^*, Antoni Arxer, MD^*, María Vieito, MD^*, Josefina Ros, MD^*, Antonio Villalonga, MD PhD^*, and Xavier Ustrell, MD

Departments of *Anesthesiology and Neurology, Girona, Catalonia, Spain

Address correspondence and reprint requests to Natàlia Aragonès, Department of Anesthesia, Hospital Universitari Doctor Josep Trueta, Av. de França s/n. 17007, Girona, Spain. Address email to anestesia{at}htrueta.scs.es

We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.

IMPLICATIONS: We describe a puerperal patient with persistent postural headache after accidental lumbar puncture in which magnetic resonance imaging showed subdural hygromas. The condition was successfully treated with an epidural patch using dextran 40.