Focal myelomalacia and syrinx formation after accidental intramedullary lidocaine injection during lumbar anesthesia: A report of 3 cases

Pradhan, Sunil; Yadav, Rashmi; Maurya, Pradeep Kumar; Mishra, Vijay Nath

doi:10.1016/j.jns.2006.09.004

Cited by 12 publications

(8 citation statements)

References 21 publications

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“…As far as the type and mechanism of the neurological complication is concerned, there are several reports in the literature describing cases of unintended subdural injection, extradural or intradural spinal haematomas causing compression of the spinal cord or the nerve roots, infection with or without abscess, direct trauma of the cord or nerve, neurotoxicity due to the injected anaesthetic1,2,3,5,7,11,12,14,15,16,17,22).…”

Section: Discussionmentioning

confidence: 99%

“…Pradhan et al16) described three cases of focal myelomalacia and syrinx formation due to accidental injection of lidocaine into the substance of the spinal cord. Halbach et al8) in their series of ten giant spinal AVFs reported one patient whose fistula cause might have been related to epidural anaesthesia traumatising a low tethered cord.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, these complications include compression of the spinal cord or nerve roots secondary to subdural or epidural haematoma or abscess, direct trauma of the spinal cord or root and neurotoxicity due to the injected anaesthetics1,2,9,11,16,17,21).…”

Section: Introductionmentioning

confidence: 99%

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Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

Baltsavias

Argyrakis

Matis

et al. 2014

J Korean Neurosurg Soc

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netic resonance imaging (MRI) demonstrating conus medullaris edema as well as dilated vessels on the cord surface. Her history began two years prior to her admission to our hospital, while she was admitted to another hospital with acute abdomen and the suspicion of a ruptured ectopic pregnancy. For some reason, most likely related to the fact that she had eaten shortly before her admission, spinal anaesthesia was decided instead of general anesthesia. Several unsuccessful attempts for access were made. She described that during those attempts she felt a sharp electric current-like sensation in both the lower extremities followed by pins and needles-like sensation. She complained intensely and further attempts were aborted. Thereafter and during her hospitalisation she was complaining of disturbing sensory symptoms involving her legs. Over the following weeks, she started to have a progressive 'numbness' of her lower limbs followed by slowly progressive spastic paraplegia over the next twenty months. During that period and especially soon after her discharge, she visited her family doctor and described her problem, which was not properly evaluated and further investigation was not followed. She was getting worse in spite of physiotherapy, which was suggested. During the last six months she developed clear spasticity and paraparesis and was investigated by MRI, which revealed conus medullaris edema and dilated vessels on the surface of the spinal cord. A vascular lesion was INTRODUCTIONEven though the real incidence of neurologic complications arising from spinal anaesthesia is not known, these seem to be very rare 2,3,5,7) . Usually, these complications include compression of the spinal cord or nerve roots secondary to subdural or epidural haematoma or abscess, direct trauma of the spinal cord or root and neurotoxicity due to the injected anaesthetics 1,2,9,11,16,17,21) . Direct arteriovenous fistulas (AVFs) are the simplest type of arteriovenous shunts of the spinal cord 1,17) . Single shunts are presented either in the context of a genetic hereditary disorder or as sporadic lesions of unknown etiology 8,10) . There has been no documented case of traumatic aetiology published so far.We report a case of an iatrogenic traumatic spinal AVF presented with progressive paraplegia in a 20-year-old young woman. The fistula had most probably resulted as a complication of repetitive lumbar punctures performed in the process of spinal anaesthesia. The value of proper technique for spinal anaesthesia is emphasized. CASE REPORTA 20-year-old female was referred to our hospital, with a history of progressive sensory-motor paraplegia and a spinal mag- A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

Baltsavias

Argyrakis

Matis

et al. 2014

J Korean Neurosurg Soc

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“…Although mainly caused by spine fracture or dislocation,1,2 SCI can also result from lumbar puncture during an epidural block 3. Because drugs such as lidocaine and its analogs can be injected into the subarachnoid space, epidural anesthesia has rare, but serious complications such as epidural or spinal subarachnoid hemorrhage and arachnoiditis, thus causing SCI with dyskinesia and chronic pain 4–6.…”

Section: Introductionmentioning

confidence: 99%

Success with neurotropin in treating pediatric lower extremity pain induced by spinal cord injury after epidural anesthesia

Zhu¹,

Zhou

Li³

et al. 2017

JPR

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Spinal cord injury (SCI) complicated by epidural anesthesia, though rare, can result in neuropathic pain. However, the treatment for this kind of life-altering injury remains a challenge. A 7-year-old girl was referred with dyskinesia and severe pain in her right lower extremity due to an accidental SCI following lumbar puncture. After treatment with analgesics such as gabapentin, mecobalamin, and dexamethasone/methylprednisolone for 1 week, the myodynamia had improved, but progressive pain persisted. After treatment with neurotropin, a gradual decrease in visual analog scale score from 7 to 0 was observed. We herein first describe that neurotropin produced sustained relief of pain induced by SCI. This case suggests that neurotropin might be a promising drug in treating pediatric neuropathic pain caused by SCI.

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“…Rutin klinik uygulamada nöroaksiyal blok uygulanacak hastalarda Tuffier çizgisinin geçtiği intervertebral aralık belirlenerek, işlem bu seviyeden yapılır. Bloğun istenilen seviyenin üstünden yapılması medulla spinalis hasarı, ciddi hipotansiyon ve bradikardi gibi komplikasyonlara neden olabilir (2)(3)(4). Özellikle ileri yaş hastalarda uygulanan spinal ve epidural anestezi sonrası görüle-bilen hipotansiyon, diferansiyel blokaj seviyesi ile koreledir (5).…”

Section: Introductionunclassified

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier’s line) in Elderly Patients

Horsanalı¹,

Tekgül²,

Özkalkanlı³

et al. 2015

Turk J Anesth Reanim

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Objective: Tuffier's line is defined as the line connecting the highest points of both iliac crests, which generally passes through either the body of the fourth lumbar vertebra or the intervertebral space between fourth and fifth vertebrae. In this study, we assessed the radiological correlation of the level of Tuffier's line with changes in age and sex. Methods:In this study, antero-posterior pelvic X-rays of 590 patients aged 18 and older were retrospectively analyzed. It is revealed that Tuffier's line crosses the vertebral column at one of three levels, which are the L4 vertebral body, L4-L5 vertebral interspace and L5 vertebral body. Patients' sex, age and vertebral level of the Tuffier's line were recorded. Data was analyzed using the chi-square test. Results:The assessment of the X-rays of 317 female patients showed that Tuffier's Line passes through the L4 vertebral body in 115 (37.8%), through the L4-L5 intervertebral space in 126 (40%) and through the L5 vertebral body in 76 (22.2%) patients. A Tuffier's line passing through the level of the L5 vertebral body was found to be statistically significant in female patients (p=0.00). No significant relevance was found between male gender and the level of Tuffier's line in 273 male patients. It is found that the height of the vertebral levels that Tuffier's line crosses does not correlate with mean age of the groups (p=0.939). Conclusion:It should be considered that Tuffier's line can cross at vertebral levels other than anticipated. The level of Tuffier's line should be precisely determined with supplementary radiological methods, such as AP pelvic X-ray in addition to physical examination, to reduce the complications in association with regional anesthesia and to achieve sensorial block levels sufficient to sustain a comfortable surgery, particularly in female patients who carry higher cardiac and respiratory risks.Keywords: Tuffier's line, crista iliac, age, sex Amaç: Tuffier çizgisi, her iki iliak kristanın en yüksek noktalarını birleştiren, genellikle 4. lomber vertebranın gövdesi veya 4 ve 5. lomber vertebralar arasından geçen çizgidir. Bu çalışmada yaş ve cinsiyetteki değişimlerle Tuffier çizgisinin seviyesi arasındaki korelasyon radyolojik olarak değerlendirilmiştir.Yöntemler: Çalışmada antero-posterior pelvis grafisi kayıtları olan 18 yaş ve üstü 590 hasta retrospektif olarak incelendi. Grafilerde Tuffier çizgisinin vertebra kolonuyla kesiştiği noktalar L4 vertebra korpusu, L4-5 intervertebral aralık, L5 vertebra korpusu olarak belirlendi. Hastaların cinsiyetleri, yaşları ve Tuffier çizgisinin geç-tiği vertebra seviyeleri kaydedildi. Veriler ki-kare testi ile değer-lendirildi.Bulgular: Çalışmada 317 kadın hastanın 115'inde (%37,8) Tuffier çizgisinin L4 vertebra korpusu, 126'sında (%40) L4-5 intervertebral aralık, 76'sında (%22,2) L5 vertebra korpusu seviyesinden geçtiği görüldü. Tuffier çizgisinin L5 vertebra korpusu seviyesinden geçmesinin kadın hasta grubunda istatistiksel olarak anlamlı olduğu saptandı (p=0,00). 273 Erkek hastada cinsiyet ile Tu...

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Focal myelomalacia and syrinx formation after accidental intramedullary lidocaine injection during lumbar anesthesia: A report of 3 cases

Cited by 12 publications

References 21 publications

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

Success with neurotropin in treating pediatric lower extremity pain induced by spinal cord injury after epidural anesthesia

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier’s line) in Elderly Patients

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