Spinal Subdural Hematoma Caused by Spinal Anesthesia in a Woman with HELLP Syndrome, A Case Report

Background: HELLP syndrome is defined as hemolysis, elevated liver enzymes, and thrombocytopenia. It has been known as a catastrophic situation that eventually occurs in the third trimester of pregnancy. Case presentation: We present a rare case of neurological complicated post-partum HELLP syndrome. A ۳۵-year-old woman underwent cesarean section in ۳۴ weeks of gestation with spinal anesthesia since worsening preeclampsia with HELLP syndrome. Although full recovery from the spinal anesthetic was achieved, on the first postoperative day she felt numbness on the distal of her lower extremities which was progressively continuing to proximal. On the second day, she noticed insensitive to bladder fullness and had mild paraparesis. Third day, she was completely flaccid paraplegic. Magnetic resonance imaging demonstrates a spinal intradural subarachnoid hematoma with extensive compression of cauda equina from L۲-L۵. Due to acute thrombocytopenia, she was consulted for emergent hematological management. Due to persistent thrombocytopenia and after correction of platelets count in ۳ post-operative days, she underwent L۲-L۵ laminectomy and intradural hematoma evacuation. Conclusions: Generally, the occurrence of spinal subarachnoid hematoma following local anesthesia is immensely small even in a coagulopathic state patient and, to our knowledge, this is the third reported case of subdural hematoma event in obstetric setting. Interestingly, concern and precise evaluation for clinicians to discern the neurological sign and symptoms of spinal subarachnoid hematoma to portend in management that might consequences in life-long neurological deficit.

Keywords:

Pregnancy , HELLP , subdural hematoma , anesthesia