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Intracranial and intraspinal hemorrhage following spinal anesthesia

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Abstract

Spinal anesthesia (SA), accounting for more than 50% of regional anesthesias in the spinal region, is generally perceived as simple and safe. Our purpose is to increase awareness of hemorrhagic complications following SA. A 69-year-old male without either coagulation disorders or anticoagulant/antiplatelet therapy developed acute radiculopathy, and severe mental confusion after SA for prostatectomy. CT showed intracranial subarachnoid and intraventricular acute hemorrhage. Cerebral angiography was negative. MRI showed subarachnoid and subdural hematoma in the dorsolumbar spine. Seven-year follow-up showed permanent cognitive and radicular damage. Multiple attempts for SA most likely caused spinal vessels rupture, either directly or indirectly by inducing differential pressure changes between cerebrospinal fluid and intravascular spaces; however, definite mechanisms have not been completely understood. Patients undergoing spinal puncture must report any neurological abnormality, which may result in irreversible damage. Cases of altered consciousness require an extensive neuroradiological evaluation. Proper competency of physicians responsible for spinal puncture is mandatory.

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Acknowledgments

We thank Tiziana Caselli from the Unit of Diagnostic and Therapeutic Neuroradiology, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle Scotte” General Hospital, Siena, Italy, for her technical support in the preparation of this article.

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Correspondence to Raffaele Rocchi.

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Rocchi, R., Lombardi, C., Marradi, I. et al. Intracranial and intraspinal hemorrhage following spinal anesthesia. Neurol Sci 30, 393–396 (2009). https://doi.org/10.1007/s10072-009-0103-1

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  • DOI: https://doi.org/10.1007/s10072-009-0103-1

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