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  • Title: Bilateral subdural hematoma after inadvertent dural puncture during epidural analgesia.
    Author: Nepomuceno R, Herd A.
    Journal: J Emerg Med; 2013 Feb; 44(2):e227-30. PubMed ID: 22959019.
    Abstract:
    BACKGROUND: Post-dural puncture headache (PDPH) is typically a benign complication of dural puncture that is clinically diagnosed. It commonly presents as a throbbing and positional headache that occurs 24-48 h after dural puncture. Subdural hematomas, if unrecognized, may occur as a rare and life-threatening complication of dural puncture. OBJECTIVES: We aim to describe the clinical features and sequelae of a rare complication that may result as a consequence of inadvertent dural puncture that, if unrecognized, has the potential to become a life-threatening complication from a common procedure. CASE REPORT: We report the case of a previously healthy 17-year-old primigravida female who initially presented 4 days postpartum with clinical features and imaging studies consistent with PDPH. The patient's symptoms were unremitting, and within 4 weeks, she developed bilateral subdural hematoma. With prompt recognition and diagnosis, she was treated with conservative medical management and subsequently improved on follow-up. CONCLUSION: Patients with unremitting PDPH should prompt the clinician to suspect the development of subdural hematoma as a potential life-threatening complication of an otherwise benign condition.
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