Factors associated with intracranial subdural haematoma formation following spinal anaesthesia among 22 patients managed at 5 hospitals over 2 years in Addis Ababa, Ethiopia: A prospective, descriptive study

Abstract

Background: Intracranial subdural haematoma (ICSDH) is a rare complication of spinal anaesthesia. This study aimed to investigate ICSDH in terms of associated factors, clinical presentation, and management at 5 hospitals in Addis Ababa, Ethiopia.

Methods: This was a hospital-based prospective cross-sectional study of patients with ICSDH following spinal anaesthesia admitted to 5 hospitals in Addis Ababa, Ethiopia, between September 2017 and February 2019. Patients’ demographic data, symptoms and duration of symptoms, time from administration of spinal anaesthesia to diagnosis, imaging findings, associated factors, type of surgery, and outcomes were entered into a data collection form. Frequencies and means were calculated to summarize the findings.

Results: Among 22 patients (mean age, 29.9±6.2 years; range, 21-45 years; 20 women) included in the analysis, 19 (86.4%) were younger than 35 years of age. The duration of symptoms ranged from 2 to 90 days, and the time to diagnosis ranged from 15 to 90 days. Headache was the main complaint of all 22 patients. Computed tomography and magnetic resonance imaging revealed chronic ICSDH and subacute ICSDH in 19 (86.4%) and 3 (13.6%) patients, respectively. Ten patients (45.5%) had bilateral haematomas. All patients except 1 were treated surgically (P<0.001). Associated factors included pregnancy (n=19, 86.4%) and multiple punctures (n=12, 54.5%). All patients were discharged without neurologic sequelae, and none of them died.

Conclusions: ICSDH after spinal anaesthesia is a serious complication. The possibility of ICSDH should be considered whenever a post–dural-puncture headache becomes nonpostural, prolonged, or whenever focal neurological signs occur.