Intradural hematoma in an adolescent: a rare complication after spinal anesthesia

Introduction. Spinal anesthesia is commonly employed in pediatric practice due to its effectiveness and safety profile. However, even when administered appropriately, there is a risk of rare but serious neurological complications, including spinal hemorrhages. The current literature contains few reports of intradural hematomas in children, particularly in cases without predisposing factors such as coagulopathies or anticoagulant therapy. The publication of this clinical case is significant because it highlights a rare instance of an intradural hematoma occurring in a clinically healthy adolescent following spinal anesthesia. This case emphasizes the need for increased awareness and enhanced diagnostic strategies within pediatric anesthesiology.

Case presentation. A 15-year-old adolescent male underwent an elective surgical procedure to remove metallic implants from the femoral bones using spinal anesthesia. The surgery and the early postoperative period were uneventful, and the patient was discharged on the third postoperative day. However, on the fourth day post-surgery, the patient developed severe lower back pain, headache, vomiting, and neck stiffness. Upon hospital admission, meningeal signs were present, along with leukocytosis (15.4∙109/L) and elevated C-reactive protein (8.9 mg/L). Spinal MRI revealed two intradural hematomas at the levels of L2 and L4 vertebrae. Cerebrospinal fluid analysis demonstrated pronounced erythrocytosis, with a cell count up to 5072/3 and a protein concentration of 3.31 g/L. Conservative management was initiated, which included therapeutic lumbar punctures, antibiotic therapy, fluid replacement, and symptomatic treatment. Over the course of treatment, the meningeal symptoms regressed, cerebrospinal fluid returned to normal levels, and laboratory parameters improved to baseline. The patient was ultimately discharged in satisfactory condition with no neurological deficits.

Conclusion. This case illustrates that intradural hematoma can occur after spinal anesthesia even in patients without coagulopathies or other risk factors. The lack of early pathognomonic signs can complicate the diagnosis, underscoring the importance of closely monitoring patients with persistent pain and meningeal symptoms during the late postoperative period. Timely MRI evaluation and appropriate management are crucial in preventing severe neurological complications.

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