# The Delayed Presentation of Bilateral Subdural Hematoma Secondary to Epidural Anesthesia for Elective Vaginal Delivery: A Case Report and Review of the Literature

## TL;DR

A rare case of delayed bilateral subdural hematoma following epidural anesthesia during childbirth is reported, highlighting the importance of early diagnosis.

## Contribution

This case report adds to the limited literature on subdural hematoma as a rare complication of epidural anesthesia.

## Key findings

- A 25-year-old woman developed bilateral subdural hematoma after epidural anesthesia, initially misdiagnosed as post-dural puncture headache.
- Surgical intervention led to a full recovery of neurological function.
- Delayed diagnosis underscores the need for vigilance in patients with unresolved symptoms after epidural anesthesia.

## Abstract

Epidural anesthesia (EA) involves reaching the spinal epidural space with an anesthetic drug injection. This procedure provides pain relief during labor. Although EA can lead to some complications, subdural hemorrhage (SDH) is a rare adverse event associated with it. We report the case of a 25-year-old female patient who presented to our emergency department with a one-month history of headaches and associated blurred vision following a normal vaginal delivery with EA. She was initially treated as a case of post-dural puncture headache (PDPH), with no improvement. Finally, the diagnosis of bilateral SDH was made based on a brain MRI. She required surgical intervention, which led to a positive prognosis and a full return of normal baseline neurological functions.

Only a few reports in the literature have indicated the possibility of cranial subdural hematoma formation associated with spinal or epidural analgesia. Our patient experienced a delay in her diagnosis and treatment, as SDH following EA is a rare entity. It is important to follow up with such patients and consider other possibilities when symptoms fail to resolve. Also, reporting these cases is crucial to assist clinicians in early diagnosis and treatment, and to avoid disastrous outcomes.