Table 1

Characteristics of patients with intracranial hematoma associated with neuraxial block

Intracranial hematoma: patient characteristicsTotal: 291n
Age (years), median (IQR)34.0 (28.0–50.0)240
Sex (male, female, missing), n (%)60 (20.6), 187 (64.3), 44 (15.1)247
BMI (kg/m2), median (IQR)25.5 (23.5–29.8)30
ASA physical status, n (%)146
 Class 113 (4.5)
 Class 2119 (40.9)
 Class 312 (4.1)
 Class 42 (0.7)
 Missing145 (49.8)
Neuraxial technique290
 Spinal anesthesia123 (42.3)
 Epidural catheter77 (26.5)
 Spinal catheter57 (19.6)
 Combined spinal–epidural procedure14 (4.8)
 Failed regional technique12 (4.1)
 Epidural injection6 (2.1)
 Spinal cord stimulator1 (0.3)
 Missing1 (0.3)
Needle size (gage)118
 <1820 (6.9)
 18–2125 (8.6)
 22–2423 (7.9)
 25–2750 (17.2)
 Missing173 (59.5)
Report of complicated puncture150
 No difficult puncture71 (24.4)
 Difficult/multiple punctures27 (9.3)
 Bloody tap1 (0.3)
 Unintended dural puncture51 (17.5)
 Missing141 (48.5)
Procedure270
 Obstetric: cesarian section76 (26.1)
 Obstetric: labor analgesia65 (22.3)
 Aneurysm repair (open or endovascular)42 (14.4)
 Minor digestive24 (8.2)
 Pain management14 (4.8)
 Urological13 (4.5)
 Major orthopedic12 (4.1)
 Gynecological oncology/surgery8 (2.7)
 Minor orthopedic6 (2.1)
 Peripheral vascular4 (1.4)
 Major digestive3 (1.0)
 Thoracic (thoracotomy/thoracoscopy)2 (0.7)
 Amputation (leg)/extremities1 (0.3)
 Missing21 (7.2)
Coagulation status99
 No regular anticoagulants74 (25.4)
 Prophylactic LMWH10 (3.4)
 Aspirin/clopidogrel6 (2.1)
 Coagulation disorder4 (1.4)
 Heparin infusion2 (0.7)
 DOAC1 (0.3)
 Unspecified anticoagulant therapy1 (0.3)
 LMWH and vitamin K antagonist1 (0.3)
 Missing192 (66.0)
Time point of complication*228
 During puncture27 (9.3)
 During treatment19 (6.5)
 After removal of catheter58 (19.9)
 After spinal anesthesia124 (42.6)
 Missing63 (21.6)
Space237
 Subdural200 (68.7)
 Subarachnoidal18 (6.2)
 Intraparenchymal12 (4.1)
 Epidural3 (1.0)
 Subdural and subarachnoidal4 (1.4)
 Missing54 (18.6)
 Unilateral, bilateral, missing, n (%)119 (40.9), 46 (15.8), 126 (43.3)165
Symptoms
 Pain (headache/neck pain) (present, absent, missing)217 (74.6), 3 (1.0), 71 (24.4)220
 Sensory deficit (present, absent, missing)50 (17.2), 128 (44.0), 113 (38.8)178
 Motor deficit (present, absent, missing)79 (27.1), 131 (45.0), 81 (27.8)210
 PDPH (present, absent, missing)101 (34.7), 16 (5.5), 174 (59.8)117
 Seizures (present, absent, missing)27 (9.3), 27 (9.3), 237 (81.4)54
 Aphasia/dysarthria (present, absent, missing)19 (6.5), 26 (8.9), 246 (84.5)45
 Visual disturbance (present, absent, missing)37 (12.7), 23 (7.9), 231 (79.4)60
 Vomiting/nausea/dizziness (present, absent, missing)74 (25.4), 15 (5.2), 202 (69.4)89
 Drowsy/disorientation (present, absent, missing)49 (16.8), 24 (8.2), 218 (74.9)73
 GCS disturbed (eg, <13) (present, absent, missing)60 (20.6), 33 (11.3), 198 (68.0)93
 GCS count if GCS disturbed, median (IQR)5.0 (3.0–7.0)24
Treatment, n (%)256
 Conservative144 (49.5)
 Neurosurgical decompression112 (38.5)
 Missing35 (12.0)
 EBP (yes, no, missing), n (%)57 (19.6), 24 (8.2), 210 (72.2)81
Recovery after treatment, n (%)216
 Full recovery117 (40.2)
 Delayed but full recovery45 (15.5)
 Partial recovery19 (6.5)
 No recovery13 (4.5)
 Death22 (7.6)
 Missing75 (25.8)
  • *‘During puncture’: symptoms during/directly after puncture, including epidural analgesia, SCS, continuous spinal anesthesia (spinal catheter) and failed regional techniques; ‘during drug administration’: when drugs were administered through a catheter or treatment with SCS was ongoing; ‘after removal of catheter’: if catheter or SCS was removed.

  • ASA, American Society of Anesthesiologists; BMI, Body Mass Index; DOAC, direct oral anticoagulants; EBP, epidural blood patch; GCS, Glasgow Coma Scale; LMWH, low-molecular-weight heparin; n, cases with available data on specific parameter; PDPH, postdural puncture headache; SCS, spinal cord stimulator.