Background: Intracranial bleeding, following spinal or neuraxial anaesthesia does not occur very commonly. Rapid intracranial decompression with a gravitational slump of the brain in the intracranial cavity, leads to the snapping of bridging and emissary vessels. This could result in bleeding within the intracranial cavity, especially in the paradural spaces, which recent reports are increasingly recognising.

Patient and Methods: We report the case of a 30-year-old lady, who underwent spinal anaesthesia for an apparently uneventful transabdominal gynaecological procedure, but developed severe progressive generalised headaches 12 days later, which subsequently, became associated with focal neurological deficits, causing a considerable diagnostic dilemma.

Results: Cranial computed tomography (CT) scan revealed a left parieto-temporal subacute extradural haematoma, which was surgically evacuated, resulting in a full neurological recovery.

Conclusion: Patients who undergo spinal anaesthesia for gynaecological and surgical procedures could come down with post-anaesthetic headaches. Recent reports are identifying complicating intracranial haematomata, in some of these cases of persistent headaches. The reports make a strong case for cranial scans in cases of persistent post-spinal puncture headaches, for definitive diagnoses and treatments.