無痛分娩後に発症した慢性硬膜下血腫の1例

Postpartum Chronic Subdural Hematoma Following Spinal Anesthesia: Case Report

Ⅰ．はじめに

　硬膜外麻酔施行時に偶発的に硬膜を穿刺すると，その後高い頻度で硬膜穿刺後頭痛（postdural puncture headache：PDPH）が出現することが知られている¹⁵⁾．無痛分娩時に偶発的に硬膜穿刺が起きる割合は0.04～6％であり³⁾，この場合発生するPDPHの頻度は50～80％と高率であるが，頭蓋内硬膜下血腫が指摘される例は稀である¹⁸⁾．今回，われわれは硬膜外麻酔による無痛分娩後に慢性硬膜下血腫へ至った症例を経験したので，文献的考察を加えて報告する．

　Chronic subdural hematoma is a rare complication of epidural anesthesia. This report describes the case of a 34-year-old woman who presented with postpartum headache after she received epidural anesthesia for labor pain. The anesthesiologist's record did not show any anesthesia-related complication. Two days after the delivery (on day 2),the patient complained of headache. Postdural puncture headache was diagnosed,so she was administered analgesics,hydration therapy,and bed rest. On day 4,she reported a slight improvement and was discharged. The postural headache persisted even on day 7 after delivery. During the conservative treatment,she had suffered a mild head trauma. On day 13,she started to feel a non-postural and severe throbbing headache. On day 24,she was referred to our department. Bilateral chronic subdural hematoma was confirmed by a computed tomography scan. Physical examination revealed only mild right hemiparesis. Left burr hole trepanation was performed and this was followed by uneventful postoperative course. Right chronic subdural hematoma was managed by conservative treatment,and it completely recovered after 4 weeks. Chronic subdural hematoma should be considered when postpartum patients who have received epidural anesthesia present with mild to severe,persistent,and non-postural headache.