Intracranial haemorrhage following lumbar myelography: case report and review of the literature

Suess, Olaf; Stendel, R.; Baur, Sourav; Schilling, A.; Brock, M.

doi:10.1007/s002340050049

Cited by 45 publications

(32 citation statements)

References 14 publications

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“…Lumbar puncture leads to a rapid decrease in intracranial pressure due to the leakage of cerebrospinal fluid from the puncture site, and intracranial hypotension occurs. This intracranial hypotension may immediately cause caudal shifting of the brain and traction of the arachnoid mater and/or venous structures (7,8). This situation may result in rupture of the fragile vasculature and intracranial haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

Beyaz¹,

Ergönenç²,

Bayar³

et al. 2013

Turk J Anesth Reanim

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Spinal anestezi sonrası intraserebral hematom çok nadir görülen bir nöro-lojik komplikasyondur ve dura ponksiyonu sonrasında oluşan intraserebral hematomun mekanizması bilinmemektedir. Herhangi bir nörolojik ve koagülasyon bozukluğu olmayan ve transüretral prostatektomi planlanan 87 yaşındaki erkek hastaya spinal anestezi uygulandı. Spinal enjeksiyondan yaklaşık 2,5 saat sonra baş ağrısı, konuşmada bozulma ve somnolans gelişen hastanın beyin CT'de intraserebral hematom tespit edildi. Yoğun bakım ünitesinde entübe edilerek mekanik ventilasyona bağlandı. Hasta postoperatif 6. gün öldü. Spinal anestezi sonrası erken dönemde gelişen nörolojik bozuklukta geri dönüşsüz beyin hasarının gelişebileceği akla gelmeli ve zaman kaybetmeden radyolojik olarak araştırılmalıdır.Anahtar Kelimeler: Spinal anestezi, dura delinmesi, intraserebral hematom Intracerebral haematoma following spinal anaesthesia is a very uncommon neurologic complication and the mechanism of intracerebral haematoma following dural puncture is not known. An 87-year-old man, who did not have any neurologic or coagulation disorder, received spinal anaesthesia for transurethral prostatectomy. Approximately 2.5 hours after spinal injection, he developed headache, slurred speech and somnolence, and brain CT revealed intracerebral haematoma. The patient was admitted to the intensive care unit and was intubated and connected to mechanical ventilator. The patient died on the 6 th postoperative day. It should be kept in mind that irreversible brain damage can develop in neurological disorders that develop soon after spinal anaesthesia and that these should be promptly evaluated radiologically.Key Words: Spinal anaesthesia, dural puncture, intracerebral haematoma Introduction N eurological complications following spinal or epidural blocks have increasingly been reported in recent years. Neurological complications that can occur following spinal anaesthesia include headache, hearing loss, epidural, subdural or subarachnoid haemorrhage, epidural abscess, and intracranial hypotension (1-4). Among these complications, intracranial haemorrhage is a relatively uncommon but fatal complication (4). In the current case, we present development of intracerebral haematoma following spinal anaesthesia, which culminated with mortality. Case ReportThe patient was an 87-year-old man who had a history of hypertension for 10 years and chronic obstructive pulmonary disease for 8 years. He underwent transurethral prostatectomy surgery under spinal anaesthesia. He had no history of known cerebrovascular disease, head trauma or headache. Physical examination and neurologic evaluation of the patient were not significant. Blood tests including coagulation were within reference ranges.Oral antihypertensive medication was continued in the preoperative period. After cannulation of a peripheral vein, 500 mL of 0.9% isotonic saline was infused within 30 minutes in the premedication room. The patient was transferred to the operation room and routine monitoring was conducted. The patient's non-in...

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Section: Discussionmentioning

confidence: 99%

A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

Beyaz¹,

Ergönenç²,

Bayar³

et al. 2013

Turk J Anesth Reanim

View full text Add to dashboard Cite

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“…This typically benign condition has been reported in settings with probable excessive loss of CSF, including lumbar puncture, myelography, ventricular shunt placement, spinal anesthesia, spinal surgery, craniotomy, and spinal trauma [5]. SDHs have been reported to occur anywhere from 1 day to weeks after a procedure [3, 5, 6, 9]. In some cases, appropriate treatment includes repair of the CSF leak suspected of causing the intracranial hypotension [5].…”

Section: Discussionmentioning

confidence: 99%

“…When excessive CSF is lost, the CSF volume decreases, and cerebral veins dilate, causing an increase in brain volume to compensate for this loss of CSF volume [14]. As a result of this CSF volume depletion, intracranial structures move caudally, putting traction on the small subdural bridging veins and activating pain-sensitive receptors [3]. Activation of these pain-sensitive receptors initiates reflex vasodilation which further predisposes the patient to SDH [15].…”

Section: Discussionmentioning

confidence: 99%

“…Circumstances causing excessive loss of cerebrospinal fluid (CSF) and concomitant intracranial hypotension resulting in SDH include lumbar puncture [2], lumbar myelography [3], CSF fistula [4], lumbar discectomy [5, 6], and administration of spinal anesthesia [7, 8]. Here we present the case of a 6-year-old girl that developed bilateral subdural fluid collections following transection of her fatty filum terminale.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Subdural Fluid Collections following Transection of a Fatty Filum Terminale: Case Report and Review of the Literature

et al. 2007

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We present the case of a 6-year-old girl who developed bilateral subdural fluid collections following transection of her fatty filum terminale. The patient presented to our emergency department 3 weeks subsequent to surgery, reporting symptoms of headache, nausea, and vomiting. The presence of bilateral subdural fluid collections was confirmed by head computerized tomography. Subdural fluid collections and hematomas have been associated with intracranial hypotension and excessive cerebrospinal fluid leakage; however, there are relatively few cases of subdural fluid collections/hematomas following spine surgery reported in the literature. To our knowledge, this is a unique description of development and resolution of subdural fluid collections following surgical transection of a fatty filum terminale.

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“…PSB'ın yaklaşık %90'ı lomber ponksiyondan sonraki ilk 72 saat içinde görülür, genellikle bir kaç gün yatak istirahati ve analjezik ajan alımıyla geçer (14). Eğer lomber ponksiyon sonrasında oluşan baş ağrısı 5 günden fazla sürüyorsa, konumla değişmiyorsa beraberinde nörolojik anormallikler, bilinç düzeyinde azalma, pitozis, parezi, pleji, bulantı varsa, klasik ağrı kesici tedaviye yanıt alınamıyorsa serebral bir olayın varlığı düşünülmelidir (15,16). Çünkü spinal anestezi öncesinde artmış kafaiçi basınç var ise intrakraniyal yapıların aşağı doğru yer değiştirmesi abartılı olur ve bu durum dördüncü ventrikülde oklüzyonun meydana gelmesiyle SS sıvısının geçişini durdurur, bunun sonucunda da hidrosefalus gelişir (17).…”

Section: Olgu Sunumuunclassified

Diagnosis Of A Cranial Tumor After İntrathecal Morphine Analgesia For Radical Retropubic Prostatectomy

Deniz¹,

Incesu²,

A³

et al. 2013

Tepecik Dergisi

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ÖZETBu olgu sunumunda genel anestezi altında radikal retropubik prostatektomi geçiren ve postoperatif analjezi için intratekal morfin uygulanan bir olguda postoperatif gelişen baş ağrısına yaklaşım sunulmuştur. Postoperatif analjezi amacıyla intratekal morfin uygulanan olguda hastanın konumuyla ilişkili olmayan baş ağrısı başladı, 1 ay sonra yüzünün sol tarafında duyu kaybı ve sol ekstremitelerinde 4/5 güçsüzlük gelişti. Nörolojik bakı ve bilgisayarlı tomografi sonrası sağ arka parietooksipital kitle tanısı kondu. Kranyotomiyle çıkarılan kitlenin medulloblastom olduğu anlaşıldı.. Sonuç olarak lomber ponksiyon sonrası konuma bağlı olmayan baş ağrısı var ise kafaiçi oluşum için ayrıntılı klinik ve radyolojik değerlendirme yapılmasının uygun olacağı düşüncesindeyiz.Anahtar Sözcükler: Baş Ağrısı, İntrakranial Tümör, Lomber Ponksiyon. SUMMARYManagement of postoperative headache which developed after radical retropubic prostatectomy under general anesthesia and intrathecal morphine for postoperative analgesia was presented in this case. The patient, who received intrathecal morphine for postoperative analgesia, had nonpostural headache. After numbness at left part of his face and 4/5 paresis on his left extremities developed a month later. Following neurological examination, computed tomography of the brain revealed a posterior parieto-occipital mass. The mass removed by a craniotomy was medulloblastoma. If there is nonpostural headache after lumbar puncture, detailed clinical and radiological evaluation is important for to detect possible intracranial events.

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Intracranial haemorrhage following lumbar myelography: case report and review of the literature

Cited by 45 publications

References 14 publications

A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

A Catastrophic Neurologic Complication Following Spinal Anaesthesia: Intracerebral Haematoma

Spontaneous Subdural Fluid Collections following Transection of a Fatty Filum Terminale: Case Report and Review of the Literature

Diagnosis Of A Cranial Tumor After İntrathecal Morphine Analgesia For Radical Retropubic Prostatectomy

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