We report a case of serious neurologic injury due to inadvertent epidural injection of 8 ml of the antiseptic 2% chlorhexidine in 70% alcohol during a procedure aimed to relieve the pain of labour. This resulted in immediate severe back pain, progressive tetraparesis and sphincter dysfunction caused by damage to the spinal cord and nerve roots. Subacute hydrocephalus necessitated drainage, but cranial nerve and cognitive function were spared. Magnetic resonance imaging documented marked abnormality of the spinal cord and surrounding leptomeninges. In the ensuing eight years, there has been clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe.Several cases of arachnoiditis subsequent to neuraxial blockade have been reported 1-7 . Typically, the neurological consequences have been devastating and irreversible. The causative agent has usually been uncertain, but the use of chlorhexidine in alcohol for skin antisepsis has been common to most recent reports 5,7 . The pathogenic role of alcohol itself is unclear.We report a case of severe neurological complications following inadvertent injection of 2% chlorhexidine in 70% alcohol into the epidural space. We compare the clinical course and radiological findings of our patient, in whom the causative agent is beyond doubt, to previously reported cases in which the cause has been speculated. We present clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe. This report is published with written consent from the patient. Case historyA 32-year-old primigravida presented at term in early labour in mid-2010. An epidural for pain relief was performed by the duty anaesthetist. Lightly tinted 2% chlorhexidine in 70% alcohol was decanted into a metal pot on the sterile field. Sterile saline was decanted into a second metal pot, which was placed at the opposite end of the field. Asepsis of the back was performed using a swab soaked in the antiseptic. The epidural needle was placed uneventfully using the loss-of-resistance to saline technique. The procedure was complicated by suspected intravascular placement of the epidural catheter, which was removed. During the repeat procedure, the loss-of-resistance syringe was filled in error with fluid from the pot containing the antiseptic, which was injected into the epidural space. This resulted in immediate, severe back pain. The error was identified, the procedure was abandoned, and the patient and her husband were informed of events. There was no sign of dural puncture. Subsequently, an effective epidural was placed at the level above and a normal vaginal delivery of a healthy child followed.In the absence of evidence to suggest that cerebrospinal fluid (CSF) drainage or lavage may be of benefit, neurosurgical and neurological opinion favoured expectant treatment. Dexamethasone 4 mg sixth-hourly was administered in the hope of limiting chemically-induced inflammation.Initially, it was difficult to assess lower limb strength due to back pain,...

We report a case of Amyloidosis of larynx in a 60-year-old adult who reported to us with hoarseness of voice of 3 years long duration and no other symptoms. Patient was treated successfully with endoscopic curettage of the mass with no inadvertent ill effects.

Foreign body inhalation is commonly seen in children who need to be treated promptly and immediately otherwise it leads to complications. We here report a rare case of foreign body detached part of metallic tracheostomy tube in left main bronchus.