Bilateral subdural hematoma a rare complication of common procedure in 30-year-old female patient: A case report and literature review

Background: Lumbar puncture (LP) is a frequent procedure done for administration of spinal anesthesia or for obtaining cerebrospinal fluid for analysis. The common complications of LP are pain at the local site and post LP headache. Rarely the following complication could occur: infections of central nervous system, brain stem herniation, and subdural hematoma. Post LP hematoma needs to be suspected in those patients whom post LP conservative management failed and headache lasts more than one week.Case presentation: We report a 30-year-old, Ethiopian woman who present with bilateral subdural hematoma following lumbar puncture for spinal anaesthesia. She presented with three weeks history of persistent headache, nausea and vomiting. The symptoms started three days following spinal anaesthesia procedure done for cesarean section.Conclusion: Post-dural puncture headache is the commonest benign complication of lumbar puncture. However, change in character of headache, absence of response to routine measures, development of neurological signs, and persistence of headache beyond one week should prompt physicians to consider rare and fatal complications of post-dural puncture such as subdural hematoma. Moreover, timely diagnosis and management is often associated with good prognosis. French title: Hematome sous dural bilateral secondaire a une ponction lombaire   Introduction: La ponction lombaire (PL) est une procédure fréquente effectuée pour l'administration de l'anesthésie rachidienne ou pour obtenir du liquide céphalo-rachidien pour analyse. Les complications courantes de la PL sont la douleur au site local et la céphalée post PL. Les complications suivantes sont plus rares : infections du système nerveux central, engagement du tronc cérébral et hématome sous-dural. Un hématome post PL doit être suspecté chez les patients dont la prise en charge conservatrice du syndrome post PL a échoué et chez lesquels les maux de tête durent plus d'une semaine. Observation :Nous rapportons le cas d’une femme éthiopienne de 30 ans qui a présenté un hématome sous-dural bilatéral après une ponction lombaire pour une rachianesthésie. Elle avait des antécédents de céphalées persistantes, de nausées et de vomissements pendant trois semaines. Les symptômes ont commencé trois jours après la procédure d'anesthésie rachidienne effectuée pour la césarienne. Conclusion: La céphalée post-PL est la complication bénigne la plus courante de la ponction lombaire. Cependant, la modification du caractère des céphalées, l'absence de réponse aux mesures de routine, le développement de signes neurologiques et la persistance des céphalées au-delà d'une semaine devraient inciter les médecins à envisager des complications rares et mortelles de la PL telles qu'un hématome sous-dural. De plus, un diagnostic et une prise en charge rapides sont souvent associés à un bon pronostic. &nbsp

Electroencephalographic Findings, Antiepileptic Drugs and Risk Factors of 433 Individuals Referred to a Tertiary Care Hospital in Ethiopia

Background: Little is known about the characteristics of electroencephalogram (EEG) findings in epileptic patients in Ethiopia. The objective of this  study was to characterize the EEG patterns, indications, antiepileptic drugs (AEDs), and epilepsy risk factors.Methods: A retrospective observational review of EEG test records of 433 patients referred to our electrophysiology unit between July 01, 2020 and  December 31, 2021.Results: The age distribution in the study participants was right skewed unipolar age distribution for both sexes and the mean age of 33.8 (SD=15.7) years. Male accounted for 51.7%. Generalized tonic clonic seizure was the most common seizure type. The commonest indication for EEG was  abnormal body movement with loss of consciousness (35.2%). Abnormal EEG findings were observed in 55.2%; more than half of them were Interictal epileptiform discharges, followed by focal/or generalized slowing. Phenobarbitone was the commonest AEDs. A quarter (20.1%) of the  patients were getting a combination of two AEDs and 5.2% were on 3 different AEDs. Individuals taking the older AEDs and those on 2 or more AEDs  tended to have abnormal EEG findings. A cerebrovascular disorder (27.4%) is the prevalent risk factor identified followed by brain tumor, HIV  infection, and traumatic head injury respectively.Conclusion: High burden of abnormal EEG findings among epileptic patients referred to our unit. The proportion of abnormal EEG patterns was  higher in patients taking older generation AEDs and in those on 2 or more AEDs. Stroke, brain tumor, HIV infection and traumatic head injury were  the commonest identified epilepsy risk factors