Peripartum neurological complications and labor epidural: an anesthesiologist predicament

Abstract

Abstract Background Dismissing the process of labor, postpartum neurological complications tend to implicate anesthetic interventions as the cause, a predicament to the anesthesiologist mandating utmost periprocedural vigilance. Case presentation Two obstetric patients with no comorbidities received uneventful labor epidurals. They presented with rare peripartum neurological complications. Conclusions Unrecognized dural puncture is often a retrospective diagnosis made with the onset of symptoms in a presumed uneventful epidural. Negative aspiration of cerebrospinal fluid (CSF) during epidural insertion does not completely rule out the dural puncture. Th dural puncture can be obscured by initial dural tenting and tear without loss of CSF, followed by a breach in the weakened arachnoid during maternal efforts (Reynolds and Speedy, Anaesthesia 45:120-3, 1990). Obstruction of the TUOHY l umen with clot or ligamentum flavum, preventing CSF flow into the needle and subarachnoid migration of a subdurally placed catheter, is another cause. Delay in management of neurological complications resulting from unrecognized dural punctures can occur.

Keywords

• Cerebral venous thrombosis (CVT)
• Post-dural puncture headache (PDPH)
• Subdural hematoma (SDH)
• Arnold Chiari malformation (ACM)
• Unintentional dural puncture (UDP)