Subarachanoid Hemorrhage Following Spinal Anaesthesia In Case Of Unknown Cerebral Aneurysm

ABSTRACT

The overall incidence of subarachnoid hemorrhage (SAH) is approximately 9 /100 000 person‐years and in which incidence in women is 1.24 times higher than in men. The exact incidence of SAH after spinal anesthesia is not known, though few cases are reported in the literature. The usual presentation of SAH following subarachnoid block (SAB) is after one or two weeks and most of the cases have history of multiple pricks during SAB with headache. We report a case of SAH following an SAB for total abdominal hysterectomy, presenting within nine hours after SAB with atypical symptoms of hypertension and generalized tonic clonic convulsions. Non contrast CT and MRI showed parafalcine grade I subarachnoid hemorrhage with vasogenic edema and venous infarcts. Subsequently it was found that patient had been suggested to undergo clipping for cerebral aneurysm ten years back. Early diagnosis with aggressive management prevented further complications in our case. Subarachnoid hemorrhage following lumbar puncture can present within 24 hour with atypical presentation. High suspicion index and further management without much hemodynamic variability can prevent fatal complications.