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Post-partum subdural hematoma revealed by persistent headache

Author(s): Fharaanojomavo R, Rafamantanantsoa S, Rabesalama F, Randriamarolahy A, Riel AM, Fenomanana M.

Introduction: The subdural hematoma is an exceptional complication of the epidural analgesia following a Dural breach causing by the leakage of cerebrospinal fluid (CSF). Its incidence after spinal anesthesia remains undetermined.Case report: We report a case of subdural hematoma in a 36-year-old woman, G4P2A1, with a medical history of spontaneous miscarriage and caesarean section, who present progressive headache after iterative caesarean section which took place at 38 weeks of amenorrhea due to placenta previa. After three days from the surgery, an epidural blood patch (EBP) has been realized because of the continuous headache complaint by the woman despite of the usual analgesics ‘administration included high dose of corticosteroids. At the 5th day, a disorder of the left oculomotor was headlined by the patient and the existence of a subduralhematoma was discovered through a Cerebral Computed Tomography. The hematoma was extended on the left front-temporal convexity with diffusion in the occipital region above to the top of the tent of the cerebellum. To face this clinical picture, a craniotomy following the drainage of the hematoma was performed. The operative follow-up was simple and without any notable consequences. Pudendal neuralgia is a neuropathic pain syndrome consisting of debilitating pain along the pudendal nerve distribution. Current evidence offers a variety of therapeutic options, however many patients demonstrate inadequate pain control. We present a 56 year old woman with an eight year history of left groin, vaginal, and rectal pain consistent with pudendal neuralgia. After failing physical therapy, pharmacologic therapy, and surgical intervention, a spinal cord stimulator was placed at the conus medullaris with subsequent 65% pain relief and improved sitting time. This report demonstrates spinal cord stimulation uniquely targeted to the conus medullary as an effective treatment modality for pudendal neuralgia.


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