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Spinal Subarachnoid Hematoma After Epidural Blood Patch 2004

Kalina, Peter, M.D., Campeau, Norbert, M.D.

This excerpta describes a complication of epidural blood patch not previously reported.

A 27 year old postpartum female developed progressive severe back pain with extension down both legs after an epidural blood patch. She was given epidural analgesia for for an otherwise routine labor. An accidental dural puncture ("wet tap") was encountered and a new level was chosen for the catheter. After an otherwise uneventful delivery, the patient developed progressive headaches which were treated with an epidural blood patch four days post-partum. For the next three days she developed progressive back pain with radicular symptoms, worse on the right.

Lumbar spine MRI revealed a large L1 to S1 intrathecal hematoma adherent to the cauda equina nerve roots.

Significant complications of epidural blood patch are uncommon. Reported cases include subdural hematoma, pneumocephalus, CSF-cutaneous fistula, facial nerve paralysis, seizures and mental status change. Our literature search suggests that this is the first report of a large well formed subarachnoid hamatoma. The presumed etiology is the inadvertant direct intrathecal administration of blood during the procedure.