A healthy 38-year-old woman was admitted to hospital due to labor pain. Combined spinal-epidural analgesia was performed. A 2 ml dose of levobupivacaine 0,125% and 10 μg of fentanyl were administrated in the intrathecal space. Afterwards the catheter was introduced in the epidural space and during aspiration cerebrospinal fluid was observed. Another attempt was realized  with the same complication. Subsequently the catheter was revised and changed. 
Preventive treatment for post-dural puncture headache (PDPH) was administrated. Day 2 the patient developed PDPH and an epidural blood patch (EBP) was performed. Initially the patient reported improvement in the headache but 24 hours after EBP she showed biparietal headache not associated to body position. A CT was performed at that moment but it didn´t show any brain injury. Due to lack of clinical improvement a magnetic resonance image (MRI) of the brain was realized, which showed bilateral intracranial subdural hematoma (SDH) supra and infratentorial.
The patient was then transferred to a third level hospital and non-surgical treatment was started. Control cranial CT showed improvement of lesions. She was discharged home with oral treatment.
Discussion
PDPH is a frequent complication after neuroaxial anesthesia, characterized by its postural character. The SDH is a rare but potentially fatal complication of dural puncture, the literature reports isolated cases and the estimated prevalence is up to 1/500000.(¹)(²)
A recent case series study reports a higher incidence of SDH up to 1/3900 and even 1/87 if it is a recognized dural puncture.(¹) Due to that, we think it is important to report all cases of SDH.
If there is a headache that does not respond to the usual treatment for PDPH, which loses its postural character and/or worsens after the completion of an EBP an intracranial complication should be suspected and a neuroradiology study should be performed. 


10 / Bilateral subdural hematoma secondary to accidental dural puncture with epidural catheter during labor