Arachnoiditis nach Spinalanästhesie – Fallbericht und Literaturübersicht

Brandt, L.; Albert, S.; Artmeier-Brandt, Ulrike

doi:10.1007/s00101-021-00938-3

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Their overall complication risk is low, and their risk of persistent neurologic deficit has been shown to range from 0 to 0.10% of patients [ 3 ]. Despite their rarity, potential neurologic complications that have been associated with epidural anesthesia include epidural hematoma, anesthetic toxicity, spinal stenosis, epidural catheter trauma, epidural abscess, hypotension due to epinephrine injection, inadvertent subarachnoid injection, meningitis, spinal cord infarction, ASA thrombosis, or arachnoiditis [ 4 , 5 ]. Thoracolumbar needle entry for these procedures can pose direct risk to the ASA due to the proximity of major aortic branches that feed the ASA [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Anterior Spinal Artery Syndrome following Spinal Anesthesia for Cesarian Section: A Case Report

Kraus,

Nguyen

2024

Case Rep Neurol

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Introduction: Spinal cord infarction is a rare but serious neurologic complication of spinal anesthesia. Direct vessel injury, intra-arterial anesthetic injection, and anesthetic-induced local hypotension are potential mechanisms of infarction during this procedure. The proximity of the artery of Adamkiewicz to the spinal levels used for spinal anesthesia may also play a role. This case of unilateral anterior spinal artery syndrome highlights the potential for an atypical pattern of injury and deficits due to the complexity of the spinal cord’s anterior circulation. Case Presentation: We present a 38-year-old female patient who presented with left lower extremity weakness, loss of temperature sensation, and urinary retention following spinal anesthesia for cesarian section. Magnetic resonance imaging of the spine demonstrated T2 hyperintensities in the left central spinal cord from T8 to the conus medullaris. A diagnosis of spinal cord infarction was made after lumbar puncture testing showed no evidence of inflammatory myelitis. The patient was treated with steroids empirically until lumbar puncture testing showed no inflammation. The patient was discharged on daily aspirin with persistent left lower extremity weakness and loss of temperature sensation. A plan for outpatient physical therapy was made for rehabilitation. Conclusion: Awareness of the potential for spinal cord infarction secondary to spinal anesthesia must increase among anesthesiologists, obstetricians, and neurologists. The risk of systemic hypotension during and after spinal anesthesia is important to recognize for both primary and secondary prevention of this complication. The hyperacute onset of myelopathic symptoms should point neurologists to investigate an ischemic etiology in the proper clinical context.

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Section: Introductionmentioning

confidence: 99%

Unilateral Anterior Spinal Artery Syndrome following Spinal Anesthesia for Cesarian Section: A Case Report

Kraus,

Nguyen

2024

Case Rep Neurol

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Fall 37 – Der Sinus pilonidalis

Hübler

2024

Komplikationen in Der Anästhesie

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Association between perioperative neuraxial local anesthetic neurotoxicity and arachnoiditis: a narrative review of published reports

Brenna,

Khan,

Poots

et al. 2023

Reg Anesth Pain Med

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Background/importanceArachnoiditis is a rare but devastating disorder caused by various insults, one of which is purported to be local anesthetic neurotoxicity following neuraxial blockade. However, the relationship between local anesthetics administered into the neuraxis and the development of arachnoiditis has not been clearly elucidated.ObjectiveWe aimed to summarize the existing complex body of literature and characterize both the essential features and strength of any association between neuraxial local anesthetic neurotoxicity and arachnoiditis with a view toward mitigating risk, enhancing prevention, and refining informed consent discussions.Evidence reviewWe reviewed all published reports of arachnoiditis attributed to local anesthetic neurotoxicity following perioperative neuraxial anesthesia. This narrative review was based on a systematic search methodology, which included articles published up until December 2022.FindingsThirty-eight articles were included, comprising 130 patients, over one-half of which were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 78 epidurals, 48 spinals, and 5 combined spinal-epidurals, mostly for obstetrics. Reporting of essential procedural data was generally incomplete. Overall, at least 57% of patients experienced complicated needle/catheter insertion, including paresthesia, pain, or multiple attempts, irrespective of technique. The onset of neurological symptoms ranged from immediate to 8 years after neuraxial blockade, while the pathophysiology of arachnoiditis, if described, was heterogeneous.ConclusionsThe existing literature attributing arachnoiditis to local anesthetic neurotoxicity is largely outdated, incomplete, and/or confounded by other potential causes, and thus insufficient to characterize the features and strength of any association.

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Arachnoiditis nach Spinalanästhesie – Fallbericht und Literaturübersicht

Cited by 3 publications

References 28 publications

Unilateral Anterior Spinal Artery Syndrome following Spinal Anesthesia for Cesarian Section: A Case Report

Unilateral Anterior Spinal Artery Syndrome following Spinal Anesthesia for Cesarian Section: A Case Report

Fall 37 – Der Sinus pilonidalis

Association between perioperative neuraxial local anesthetic neurotoxicity and arachnoiditis: a narrative review of published reports

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