To the Editor: Epidural analgesia is an effective technique to relieve pain during labor.1 Intracranial subdural hematoma (ISH) can present as a rare neurological complication associated with epidural analgesia following dural puncture.2–5 We describe an intracranial subdural hematoma following the epidural injection with no dural perforation in a patient undergoing vaginal delivery. A 25-year-old pregnant woman was admitted to the hospital for delivery She was primiparous, at 39-weeks gestation, with an uneventful pregnancy course and a normal hematologic screen. There was no significant history of illness. After she provided informed consent and with her approval, an epidural needle was inserted at L3–L4. There were no complications during the administration of the epidural catheter. After the test dose of 2 mL 2% lidocaine, 5 mL 0.5 % bupivacaine plus 5 mL normal saline were administered initially and as a top-up dose in 90 minutes. Following injections the patient was hemodynamically stable based on arterial blood pressures and heart rates. During delivery, 2.5 mL of 0.5% bupivacaine and an equal volume of normal saline were injected epidurally The patient had adequate motor power and the second stage of labor lasted 30 minutes. The first and fifth minute Apgar scores of the new-born were 8 and 10, respectively. The patient was discharged on the postpartum day. One week after the delivery, the patient was admitted to the hospital with recurrent paresthesia in her right arm (7 to 8 times/day) lasting for 10 to 15 minutes. Her history elicited pain, which was spreading from right wrist to the forearm and occasionally to the face, beginning two days after the delivery. She had temporary, intermittent lethargy and frontal bilateral headache that was postural in nature, exacerbated with leaning forward and decreased with the horizontal position. On physical examination, she had no abnormal findings except superficial hypoalgesia in her right forearm. Laboratory investigations showed only a high erythrocyte sedimentation rate. Vertebral artery and carotid colored Doppler blood flow measures and heart functions with echocardiography were all in normal ranges. Computerized brain tomography of the skull showed sulcal effacement in the left parietal region, isodense subdural hematoma in the supratentorial region and displacement in grey substance-Luschke interphase. Subdural hematoma in the left parietal region was confirmed with magnetic resonance imaging. She had been hospitalized and medically treated for cerebral contusion six years earlier because of head trauma. She also had suffered from occasional headaches. She was medically discharged on the seventh day without neurologic complication. Contrasted computerized tomography performed 3 weeks later showed that the hematoma was completely resolved.Epidural blocks are widely used in obstetrics for the pain relief of labor and delivery.1,2 After accidental dural puncture the late neurologic complications such as epidural or subdural hematoma, subdural cyst, arachnoiditis, subdural hygroma were reported.3,5,6 Besides dural injury and coagulation defects, preeclampsia, or large volume (=25–30ml) and rapid injection of a solution into the epidural space may lead also increases intracerebral hemoragia risk.5,6 In our case, etiological factors such as preeclampsia, coagulation abnormalities, and dural injury were excluded and less than 20 mL volume was administered very slowly for epidural analgesia.7–9 The history of head trauma may be an etiological factor for subdural hematoma. It was also suggested that the pressure changes during vaginal delivery might increase the risk of subdural hematoma.10 The alternative diagnosis was spontaneous tear of intracranial blood vessels weakened by past head injury and caused by the valsalva maneuver during the second stage of labor. A previous history of head injury should be inquired in a patient with headaches following epidural anesthesia.In conclusion we suggest that attacks of paresthesia in the upper body following epidural anesthesia even without any dural injury should be a reminder of intracerebral subdural hematoma which may be life threatening if not properly treated.