Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne. PDF | JUSTIFICATIVA E OBJETIVOS: A cefaleia pós-punção dural é uma pequena parcela dos casos após a realização da raquianestesia. Título: Tampåo sangüíneo peridural e alta hospitalar precoce: análise de 60 pacientes portadores de cefaléia pós-raquianestesia / Epidural blood patch and.


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Npantone tpx colors pdf

The cholelithiasis is the main biliary tract disease that affects a significant amount of the population, an issue of cefaleia pos raquianestesia public health. In Brazil, is the most common surgical abdominal disease, with abouthospitalizations annually by the Unified Health System SUS.

This endothelial dysfunction predisposes to the development of pregnancy-induced hypertension Cardiovascular and Cerebrovascular disease are also worrisome due to the frequent association of obesity and hypertension, type 2 diabetes, hyperlipidemia, and myocardial dysfunction 15, In those patients dilutional anemia compromises transport and tissue delivery of oxygen especially in cases of acute bleeding The pro-coagulant state associated with decreased mobility makes obese pregnant women a risk group for thrombotic events 15, Previously obese pregnant women are more prone to antenatal and gestational comorbidities such as chronic hypertension, diabetes, and preeclampsia, besides the greater chance of the development of fetal cardiac anomalies, macrosomia, and fetal shoulder cefaleia pos raquianestesia 2.

Some of those conditions can alter the consequences of anesthesia in those patients.

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In obese pregnant women undergoing cesarean section, spinal anesthesia remains cefaleia pos raquianestesia most used anesthetic technique 15 due to historical advantages in obstetrics. Revista Brasileira de Anestesiologia Vol. Then, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus.

She did not have headache history.

  • Prevalencia de cefaleia pós-raquianestesia no Hospital Universitário Gaffrée e Guinle
  • Prevalencia de cefaleia pós-raquianestesia no Hospital Universitário Gaffrée e Guinle
  • Prevalencia de cefaleia pós-raquianestesia no Hospital Universitário Gaffrée e Guinle
  • Prevalencia de cefaleia pós-raquianestesia no Hospital Universitário Gaffrée e Guinle
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On physical examination in dorsal decubitus, the patient had only cefaleia pos raquianestesia of pain, without other alterations.

She was medicated with hydration, dipyrone and tenoxicam and requested evaluation by a neurologist, due to the unusual characteristic of headache. Neurological examination was normal, but the patient reported transient lacunar amnesia from beginning of headache until improvement, after being medicated.


A cranial tomography was requested and showed the presence of an acute left frontotemporoparietal subdural hematoma Figure 1A. On the following day, a magnetic resonance was performed showing extra-axial collection, with mass effect characterized by deletion of grooves between cefaleia pos raquianestesia cortical gyri and deviation of structures of the median line Figures 1B and 1C.

Intracranial arterial magnetic resonance cefaleia pos raquianestesia showed no significative abnormalities Figure 1D.


The patient was medicated with analgesics, dexamethasone and hydantoin with important improvement of the clinical cefaleia pos raquianestesia. The evaluation by the neurologist indicated a conservative treatment.

The patient was discharged after using dexamethasone and hydantoin for three days.


When she interrupted the dexamethasone use after 17 days, she had intense headache, followed by dormancy and paresis of the right upper limb cefaleia pos raquianestesia speech and behavior disorders.

She reported constant headache moderate intensity within this period of 17 days.

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The patient recovered well and was discharged in two days. It is important due to the fact that it is a potentially fatal complication.

The reported case illustrates well that first manifestations can be the same cefaleia pos raquianestesia the patient has a single clinical picture of post-dural puncture headache, which complicates the early diagnosis of intracranial subdural hematoma.

Since the first reports described by Bier at the end of the 19th century, headache is still an unsolved complication of spinal anesthesia, even using finer needles or with blunt tip 3. The patient is at risk of developing headache whenever the dura mater and arachnoid membranes are punctured.

It is still the main complication of spinal blocks and is characterized by worsening in the cefaleia pos raquianestesia 15 minutes after the patient is in the orthostatic position and its improvement within 30 minutes Figure 1 — A: Studies also indentified a higher incidence of PDPH in females.