Unrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging

Corbonnois, G.; O’Neill, Thomas; Brabis-Henner, A.; Schmitt, Emmanuelle; Hubert, I.; Bouaziz, Hervé

doi:10.1016/j.annfar.2010.06.002

Cited by 13 publications

(6 citation statements)

References 22 publications

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“…Of the 114 reviewed cases, 19 epidural blood patches (EBPs) were used: 2 before diplopia onset, 9,24 7 during the first 24 hours after diplopia onset, 8,17,[25][26][27][28][29] and 8 EBPs 24 hours after diplopia onset. 2,27,[30][31][32][33][34][35] The other cases were not notified in time to undertake EBP.…”

Section: Resultsmentioning

confidence: 99%

“…24,27,30 Epidural blood patch is most effective for treating PDPH (93% effectiveness), but it has not been demonstrated to be an efficacious treatment for EOMP. 8,25,27,28,30,33,36,50 In the 114 cases in our review, 2 patients underwent prophylactic EBP during the first 24 to 48 hours. Nevertheless, it did not restore the function of cranial nerves, not even when headaches were fully resolved, and both cases required surgery.…”

Section: Resultsmentioning

confidence: 99%

“…7,17,33,50 However, some authors recommend performing surgery after 18 months, which are considered long recovery cases. 28,67,68 Decisions should be made on an individualized basis, and not only on symptom duration (at least 8 months) and severity, but by also assessing the risks and benefits of corrective surgery.…”

Section: Resultsmentioning

confidence: 99%

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Ocular Motor Palsy After Spinal Puncture

del-Río-Vellosillo

García-Medina

Pinazo-Durán

et al. 2017

Regional Anesthesia and Pain Medicine

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Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6-71 years). The sixth cranial nerve was the most commonly involved (92.1%), with higher frequency in the right eye. Palsy onset started 7.30 ± 4.09 days after puncture. Duration in reversible cases was 80.10 ± 80.67 days. Paresia was permanent in 13 patients, but only 2 patients required extraocular muscle surgery. Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Ocular Motor Palsy After Spinal Puncture

del-Río-Vellosillo

García-Medina

Pinazo-Durán

et al. 2017

Regional Anesthesia and Pain Medicine

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show abstract

“…[891020] The first patient developed intracranial hypotension alone, whereas the second patient exhibited both intracranial hypotension and double vision; both were successfully treated with epidural blood patches (EBP). [820] The third patient was a 39-year-old female who developed postural headaches 20 hours after her epidural injection; she required an EBP (epidural blood patch) 48 hours post- injection. [9] However, 14 days later, with headaches, expressive dysphasia, lack of coordination, and sensory loss in the right arm, she underwent an MR scan that documented a left SDH; she required a craniotomy, for which she required a craniotomy.…”

Section: Inadvertent Lumbar Intradural Injections Occurring During Atmentioning

confidence: 99%

Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections

Epstein¹

2017

Surg Neurol Int

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Background:Various types of lumbar dural punctures may contribute to neurological injury. The etiologies of dural injury include; inadvertent dural punctures due to epidurals placed for labor anesthesia, epidural steroid injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the US per year), deliberate placement of intradural pain devices, and spontaneous cerebrospinal fluid (CSF) fistulas. Resulting neurological complications may include; spinal headaches/intracranial hypotension, subdural hematomas, and 6th nerve cranial palsies. Furthermore, uniquely in the cervical spine, inadvertent cervical dural punctures attributed to cervcial ESI (CESI) may lead to intramedullary spinal cord injuries (e.g. resulting in monoparesis to quadriplegia) or spinal cord strokes due to intravascular/vertebral artery injections.Methods/Results:In 8 studies, inadvertent lumbar dural punctures contributed to intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. In 5 of the 6 studies, inadvertent dural punctures occurring during CESI were responsible for intramedullary spinal cord injuries, or direct intravascular/vertebral injections resulting in monoplegia/quadriplegia.Conclusions:Inadvertent lumbar dural punctures led to multiple neurological complications including intracranial hypotension, subdural hematomas, and double vision/6th cranial nerve palsies. Uniquely, inadvertent cervical dural punctures solely due to CESI directly resulted in intramedullary spinal cord injuries or cord stroked and monoplegia/quadriplegia attributed to intravascular/vertebral artery injections. The potential neurological risks/complications/adverse events attributed to lumbar and cervical ESI must be taken into account before spine surgeons and others order these procedures.

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“…Acquired Chiari I malformation has also been reported due to intracranial hypotension, intracranial hypovolemia, or following epidural analgesia with a CSF leak (90). The patient presents with chronic headaches and diplopia often due to a comitant esotropia.…”

Section: Postpartum Complicationsmentioning

confidence: 99%

Neuro-Ophthalmology and Pregnancy

Digre

2011

Journal of Neuro-Ophthalmology

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Management of the pregnant woman with a neuro-ophthalmic disorder may be challenging. Physiologic changes in pregnancy make vascular conditions more frequent, including retinal artery occlusion, spontaneous orbital hemorrhage, and pituitary apoplexy. Papilledema may signal cerebral venous sinus thrombosis or idiopathic intracranial hypertension. Manifestations of severe preeclampsia and eclampsia include choroidal infarction, serous retinal detachment, and disorders of higher cortical function, such as alexia, simultanagnosia, and cerebral blindness. Cranial neuropathies have also been reported. Transient Horner syndrome, intracranial hypotension with comitant esotropia may occur in the postpartum period. Treatment of the neuro-ophthalmic complications of pregnancy requires an understanding of the risks of medications. Taking optimal care of the mother will usually result in the best care for her baby.

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Unrecognized dural puncture during epidural analgesia in obstetrics later confirmed by brain imaging

Cited by 13 publications

References 22 publications

Ocular Motor Palsy After Spinal Puncture

Ocular Motor Palsy After Spinal Puncture

Neurological complications of lumbar and cervical dural punctures with a focus on epidural injections

Neuro-Ophthalmology and Pregnancy

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