DELAYED BILATERAL FRONTOPARIETAL SUBDURAL HEMATOMAS FOLLOWING SPINAL ANESTHESIA FOR CESAREAN DELIVERY IN A TWIN PREGNANCY: A CASE REPORT

Introduction: Intracranial subdural hematoma is a rare but potentially life-threatening complication of spinal anesthesia. Its diagnosis may be delayed because the initial symptoms often resemble post-dural puncture headache. Case Presentation: We report the case of a 23-year-old woman, gravida 1 para 2, with no significant medical or surgical history, who underwent cesarean delivery under spinal anesthesia for a term twin pregnancy. The first twin was in breech presentation and the second in cephalic presentation. Spinal anesthesia was performed at the L3-L4 interspace using a 25-gauge Quincke needle and required a single uncomplicated attempt. The patient received postoperative prophylactic low-molecular-weight heparin for seven days. Ten days after delivery, she developed mild-to-moderate headaches that progressively worsened and became associated with visual disturbances. Twenty-two days after cesarean section, she was admitted for further evaluation. Neurological examination revealed a Glasgow Coma Scale score of 15/15, equal and reactive pupils, and no sensory or motor deficits. Visual field impairment involving the right eye was noted. Hemodynamic parameters were stable testing was negative. Brain computed tomography demonstrated bilateral frontoparietal subdural hematomas measuring 19 mm on the right side and 21 mm on the left side, with bilateral fluid-blood levels. The ventricular system was normal and the cerebral midline remained centered. Enlargement of the perioptic nerve sheaths was also observed. The patient underwent bilateral burr-hole drainage under sedation with laryngeal mask airway management. Postoperatively, headaches resolved completely and visual symptoms progressively improved.