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Incidence and Predictors of Inadvertent Dural Puncture After Percutaneous Spinal Cord Stimulation: A Retrospective Data Base Analysis. Neuromodulation 2022:S1094-7159(22)00760-7. [PMID: 35977852 DOI: 10.1016/j.neurom.2022.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Inadvertent dural puncture (IDP) is a known complication associated with traditional neuraxial procedures; however, its characterization after percutaneous spinal cord stimulation (SCS) lead placement has yet to be clearly established in large population studies. This retrospective analysis aims to understand the incidence and associated characteristics of patients with IDP after percutaneous SCS lead placement. MATERIALS AND METHODS The PearlDiver Mariner database of national all-payer claims was used to identify patients who received percutaneous SCS leads and had a claim for IDP (intraoperative IDP or postdural puncture headache [PDPH] claim) within 45 days. The primary outcome was to determine the overall incidence of IDP. Secondary outcomes included an evaluation of associated risk factors for IDP and treatments used in symptomatic management. RESULTS A total of 90,952 patients who underwent percutaneous lead SCS placement were included. The incidence of IDP was 0.48% (436/90,952 patients). Older age (odds ratio [OR]: 0.96; 95% CI: 0.95-0.97; p < 0.0001) and male sex (OR: 0.66; 95% CI: 0.53-0.81; p < 0.001) had a lower odds of having a claim for IDP, whereas a history of IDP was associated with a higher OR (95% CI) by 13.72 times (10.72-17.58) (p < 0.0001). Of the IDP patients, 64% (277/436 patients) had a claim for a therapeutic blood patch. Discrepancy in type of claim for IDP was observed, with most being for PDPH. CONCLUSIONS Our findings suggest that IDP after percutaneous SCS lead placement is an uncommon event; however, certain factors are associated with its development. Overall, early recognition of IDP after percutaneous SCS lead placement is imperative to facilitate the delivery of targeted treatments and prevent further harmful consequences to the patient.
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Xiang T, Zhang X, Wei Y, Feng D, Gong Z, Liu X, Yuan J, Jiang W, Nie M, Fan Y, Chen Y, Feng J, Dong S, Gao C, Huang J, Jiang R. Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review. Front Neurol 2022; 13:900145. [PMID: 35937065 PMCID: PMC9354981 DOI: 10.3389/fneur.2022.900145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.
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Affiliation(s)
- Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Dongyi Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yupeng Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
- *Correspondence: Rongcai Jiang
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Mark IT, Dillon WP, Richie MB, Villanueva-Meyer JE. MRI Findings after Recent Image-Guided Lumbar Puncture: The Rate of Dural Enhancement and Subdural Collections. AJNR Am J Neuroradiol 2022; 43:784-788. [PMID: 35483908 PMCID: PMC9089257 DOI: 10.3174/ajnr.a7496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The rate of abnormal intracranial MR imaging findings including subdural collections and dural enhancement after recent lumbar puncture is not known. The purpose of our study was to examine the intracranial MR imaging findings after recent image-guided lumbar puncture. MATERIALS AND METHODS Patients who underwent contrast-enhanced MR imaging of the brain within 7 days of a CT-guided lumbar puncture between January 2014 and April 2021 were included. Contrast-enhanced MR images were reviewed for diffuse dural enhancement, morphologic findings of brain sag, dural venous sinus distension, and subdural collections. RESULTS Of the 160 patients who met the inclusion criteria, only 6 patients (3.9%) had new diffuse dural enhancement, though none had dural enhancement when the MR imaging was within 2 days of lumbar puncture. All 6 patients with dural enhancement had small, concurrent subdural collections. Two additional patients had subdural collections, for a total of 5.2% of our population. CONCLUSIONS Our study is the first to examine intracranial MR imaging after recent lumbar puncture and has 2 key findings: First, 5.2% of patients had small, bilateral subdural collections after recent lumbar puncture, suggesting that asymptomatic subdural collections after recent lumbar puncture are not atypical and do not require further work-up. Additionally, when MR imaging was performed within 2 days of lumbar puncture, none of our patients had diffuse dural enhancement. This argues against the commonly held practice of performing MR imaging before lumbar puncture to avoid findings of dural enhancement, and should not delay diagnostic work-up.
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Affiliation(s)
- I T Mark
- From the Departments of Radiology and Biomedical Imaging (I.T.M., W.P.D., J.E.V.-M.)
| | - W P Dillon
- From the Departments of Radiology and Biomedical Imaging (I.T.M., W.P.D., J.E.V.-M.)
| | - M B Richie
- Neurology (M.B.R.), University of California, San Francisco, San Francisco, California
| | - J E Villanueva-Meyer
- From the Departments of Radiology and Biomedical Imaging (I.T.M., W.P.D., J.E.V.-M.)
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Vynogradova I, Pauli SU, Heckmann JG. Intracranial epidural hematoma following lumbar puncture. Acta Neurol Belg 2021; 121:1365-1366. [PMID: 33840051 PMCID: PMC8443501 DOI: 10.1007/s13760-021-01621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Iryna Vynogradova
- Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, 84034, Landshut, Germany
| | - Steffen Ulrich Pauli
- Department of Neurosurgery, Municipal Hospital Landshut, 84034, Landshut, Germany
| | - Josef Georg Heckmann
- Department of Neurology, Municipal Hospital Landshut, Robert-Koch Str. 1, 84034, Landshut, Germany.
- Medical Faculty, University of Erlangen-Nuremberg, 91054, Erlangen, Germany.
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Ngebe EK, Uwamahoro E, Irakoze M, Ruzindana K, Olufolabi AJ. Rare but Fatal Subdural Hematoma Following Spinal Anesthesia: A Case Report of Unrecognized Untreated Postdural Puncture Headache in a Low-Resource Country Setting. A A Pract 2021; 14:e01265. [PMID: 32909717 DOI: 10.1213/xaa.0000000000001265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Dural puncture following neuraxial anesthesia can cause persistent cerebrospinal fluid leakage. A 35-year-old, 39-week gestation healthy parturient underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed using a 25-gauge Quincke needle. Despite the occurrence of postoperative positional headache and neck pain, she was discharged home. Two weeks following discharge, she developed seizures and deteriorating level of consciousness. Brain computerized tomography scan revealed massive left subdural hematoma. She died 3 days later. We discuss awareness of neuraxial complication among maternity staff, effective follow-up, and available management strategy in low-resource settings. Persistent headache following neuraxial anesthesia should be investigated.
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Affiliation(s)
| | | | - Magnifique Irakoze
- Obstetrics and Gynecology, Central Hospital University of Kigali, Kigali, Rwanda
| | - Kenneth Ruzindana
- Obstetrics and Gynecology, Central Hospital University of Kigali, Kigali, Rwanda
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Dehaene S, Biesemans J, Van Boxem K, Vidts W, Sterken J, Van Zundert J. Post-Dural Puncture Headache Evolving to a Subdural Hematoma: A Case Report. Pain Pract 2020; 21:83-87. [PMID: 32652880 PMCID: PMC7818122 DOI: 10.1111/papr.12937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/25/2022]
Abstract
Introduction Cervical epidural corticosteroid injections are frequently used for the treatment of subacute cervicobrachial pain. This therapy is considered safe, with the vast majority of the complications being minor and transient. Case Report We present a case of a woman in her fifties who suffered from cervicobrachialgia and received 2 cervical epidural corticosteroid infiltrations. On day 3 after the second infiltration, a new headache appeared and on day 16 a bilateral subdural hematoma was visualized on CT scan. Complete resorption of the hematoma was seen on day 25 without surgical intervention. Discussion Up until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published. But several cases of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have been reported. Physicians should be aware of this potentially dramatic complication since post‐dural puncture headache after any type of procedure can evolve into a subdural hematoma. Clinical differentiation between the two can be difficult; post‐dural puncture headache is characterized by relief of symptoms in the supine position and photophobia/phonophobia. A subdural hematoma should be considered if the headache changes in character, does not respond to treatment, or there are neurological signs such as nausea/vomiting and blurred vision. Immediate medical imaging should then be performed.
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Affiliation(s)
- Seppe Dehaene
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, OLV van Lourdes Ziekenhuis, Waregem, Belgium.,Department of Anesthesiology, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jeroen Biesemans
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, OLV van Lourdes Ziekenhuis, Waregem, Belgium
| | - Koen Van Boxem
- Department of Anesthesiology, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Wesley Vidts
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, OLV van Lourdes Ziekenhuis, Waregem, Belgium
| | - Joeri Sterken
- Department of Anesthesiology, Intensive Care, Pain and Emergency Medicine, OLV van Lourdes Ziekenhuis, Waregem, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.,Department of Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Rosario LE, Rajan GR. Repeat Subdural Hematoma After Uncomplicated Lumbar Drain Discontinuation: A Case Report. A A Pract 2020; 13:107-109. [PMID: 30907750 DOI: 10.1213/xaa.0000000000001005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lumbar drains are commonly placed to monitor spinal cerebrospinal fluid (CSF) pressures and drain CSF to augment spinal cord perfusion. Excessive CSF drainage or persistent leakage through the dural puncture site can lead to cerebral hypotension and creation of an intracranial subdural hematoma. Anesthesia providers need to be aware of the risk of subdural hematoma development after major thoracoabdominal surgery where placement and subsequent removal of a lumbar drain have occurred. We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.
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Affiliation(s)
- Lauren E Rosario
- From the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
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8
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Amoretti N, Baqué J, Litrico S, Stacoffe N, Palmer W. Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided Interlaminar Epidural Steroid Injection. Cardiovasc Intervent Radiol 2019; 42:775-778. [PMID: 30603972 DOI: 10.1007/s00270-018-2151-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
We describe the case of a 30-year-old patient who was referred for lumbar epidural corticosteroid injection due to right L5 radiculopathy. Two months earlier, MRI demonstrated a right large paracentral L4-L5 disk extrusion causing disabling L5 radiculopathy. The L4-L5 level was selected for interlaminar injection, using fluoroscopic guidance. During injection, the patient developed severe pain in both lower extremities. Thus, the procedure was immediately terminated. Paraplegia occurred within several minutes. Urgent lumbar spine CT and MRI demonstrated contrast material in a massive extruded disk fragment and substantial increase in size of the disk extrusion compared to pre-injection MRI. Emergency surgery was performed for lumbar decompression and discectomy. Although rare, serious neurological complication can result from inadvertent intradiscal injection of contrast material during lumbar epidural injection. This case illustrates the importance of recognizing the possibility of dynamic change in the size of an extruded disk fragment when the MRI precedes injection by a substantial time interval. LEVEL OF EVIDENCE: IV, Case Series.
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Affiliation(s)
- Nicolas Amoretti
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France.
| | - Jean Baqué
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Stéphane Litrico
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Nicolas Stacoffe
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
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Hellstrand K, Hoppa E. Low Back and Leg Pain With Refusal to Ambulate in a 6-Year-Old Male. Clin Pediatr (Phila) 2016; 55:1260-1262. [PMID: 26538588 DOI: 10.1177/0009922815615831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Eric Hoppa
- Connecticut Children's Medical Center, Hartford, CT, USA
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10
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Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma. Case Rep Anesthesiol 2016; 2016:5789504. [PMID: 27651956 PMCID: PMC5019880 DOI: 10.1155/2016/5789504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022] Open
Abstract
Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.
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11
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Active extravasation of gadolinium-based contrast agent into the subdural space following lumbar puncture. Clin Imaging 2016; 40:591-3. [PMID: 27317202 DOI: 10.1016/j.clinimag.2016.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/20/2022]
Abstract
A 38year-old male presented with cauda equina syndrome following multiple lumbar puncture attempts. Lumbar spine magnetic resonance imaging (MRI) showed a subdural hematoma and an area of apparent contrast enhancement in the spinal canal on sagittal post-contrast images. Axial post-contrast images obtained seven minutes later demonstrated an increase in size and change in shape of the region of apparent contrast enhancement, indicating active extravasation of the contrast agent. This is the first reported case of active extravasation of gadolinium-based contrast agent in the spine.
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Purkait R, Dolai TK, Lath C, Das B. Intracranial Hemorrhage Following Intrathecal Methotrexate Therapy for Acute Lymphoblastic Leukaemia. Indian Pediatr 2016; 53:423-4. [PMID: 27254055 DOI: 10.1007/s13312-016-0866-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute toxic leukoencephalopathy following intrathecal methotrexate administration is well documented but intracranial haemorrhage is extremely rare. CASE CHARACTERISTICS A 2-year-6 months old girl with acute lymphoblastic leukemia developed sudden onset neurological deterioration following intrathecal methotrexate. OBSERVATIONS Computed tomography scan of brain demonstrated intraventricular and subarachnoid hemorrhage. OUTCOME Child improved gradually on conservative management. Follow-up neuroimaging showed resolution of hemorrhage. MESSAGE Intracranial haemorrhage is a rare but serious complication of intrathecal methotrexate.
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Affiliation(s)
- Radheshyam Purkait
- Departments of Pediatric Medicine and *Haematology, NRS Medical College and Hospital, Kolkata, West Bengal, India. Correspondence to: Dr Radheshyam Purkait, Department of Pediatric Medicine, NRS Medical College and Hospital, Kolkata 700 014, West Bengal, India.
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McDougall RJ, Barnes R, Danks RA, Ditchfield M. Subdural haematoma following infant spinal anaesthesia. Childs Nerv Syst 2016; 32:579-81. [PMID: 26255150 DOI: 10.1007/s00381-015-2862-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Subdural haematoma (SDH) is rare following spinal anaesthesia and has not been reported previously in an infant. Non-accidental injury is the commonest cause of subdural haematoma in infants. METHODS We describe two cases of SDH following spinal anaesthesia in infants. RESULTS In both cases, forensic investigation was commenced and no evidence of child abuse was found. Both children are well 2 years after diagnosis. CONCLUSION Paediatric health workers should be aware of the possibility of SDH after spinal anaesthesia and consider this as a differential diagnosis when investigating possible non-accidental injury in an infant.
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Affiliation(s)
- Robert J McDougall
- Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Australia.
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville, VIC, Australia.
| | | | - R Andrew Danks
- Department of Surgery, Monash University, Clayton, Australia
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Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth 2016; 25:58-65. [DOI: 10.1016/j.ijoa.2015.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
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15
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Hulou MM, Abd-El-Barr MM, Gormley WB, Zamani AA, Dunn IF, Al-Mefty O. The frequency and severity of intracranial hypotension post-intraoperative lumbar drainage using a Tuohy needle and the traditional needle. Br J Neurosurg 2016; 30:438-43. [DOI: 10.3109/02688697.2015.1122172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE The objective of this article is to detail the indications, techniques, risks, and benefits of fluoroscopically guided lumbar puncture (LP). CONCLUSION Familiarity with the details of fluoroscopically guided LP can aid in the work flow, increase the success rate, and minimize the complications of the procedure.
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DEL-RIO-VELLOSILLO M, GARCIA-MEDINA JJ, FERNANDEZ-RODRIGUEZ LE, MARTIN-GIL-PARRA R, LOPEZ-PEREZ J, ALMAGRO-NAVARRO MJ. Subdural hygroma accompanied by parenchymal and subarachnoid haemorrhage after epidural analgesia in an obstetric patient. Acta Anaesthesiol Scand 2014; 58:897-902. [PMID: 24628098 DOI: 10.1111/aas.12308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anaesthetists need to know the different causes of persistent headache or a change in level of consciousness following epidural analgesia for labour. Failure to recognise these neurological complications can lead to delayed diagnoses, with subsequent serious implications. METHODS We present a patient who was re-admitted for postural headache resulting from an unrecognised dural puncture during an epidural for pain relief while in labour. During the interview, the patient confirmed drug use (cocaine), so she was evaluated by a psychiatrist with possible post-partum psychosis or drug withdrawal syndrome. Afterwards, the patient deteriorated neurologically, showing impaired consciousness and seizures. RESULTS The cranial computed tomography showed bilateral frontoparietal subdural collections with intraparenchymal and subarachnoid haemorrhaging. She improved by burr hole drainage of subdural hygroma and a blood patch. CONCLUSIONS Neurological signs should alert the clinician to the possibility of subdural collection and other possible complications such as sinking of the brain in order not to delay the request for imaging tests for diagnoses and effective treatments.
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Affiliation(s)
| | - J. J. GARCIA-MEDINA
- Department of Ophthalmology and Optometry; School of Medicine; University of Murcia; Murcia Spain
- Department of Ophthalmology; General University Hospital Reina Sofia; Murcia Spain
| | | | - R. MARTIN-GIL-PARRA
- Department of Anesthesia; University Hospital Virgen de la Arrixaca; Murcia Spain
| | - J. LOPEZ-PEREZ
- Department of Anesthesia; University Hospital Virgen de la Arrixaca; Murcia Spain
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Rucklidge OM. All patients with a postdural puncture headache should receive an epidural blood patch. Int J Obstet Anesth 2014; 23:171-4. [DOI: 10.1016/j.ijoa.2013.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 12/13/2022]
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Peña-Irún Á, González-Santamaría AR. [Bilateral subdural hematoma after diagnostic lumbar puncture]. Rev Clin Esp 2014; 214:111-2. [PMID: 24439669 DOI: 10.1016/j.rce.2013.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/30/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Á Peña-Irún
- Centro de Salud El Sardinero, Santander, España.
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Nepomuceno R, Herd A. Bilateral Subdural Hematoma after Inadvertent Dural Puncture during Epidural Analgesia. J Emerg Med 2013; 44:e227-30. [DOI: 10.1016/j.jemermed.2012.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/22/2012] [Accepted: 06/30/2012] [Indexed: 10/27/2022]
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Imagama S, Wakao N, Ando K, Hirano K, Tauchi R, Muramoto A, Matsui H, Matsumoto T, Ukai J, Kobayashi K, Shinjo R, Nakashima H, Maruyama K, Matsuyama Y, Ishiguro N. Treatment for primary spinal atypical teratoid/rhabdoid tumor. J Orthop Sci 2012; 17:822-7. [PMID: 21720800 DOI: 10.1007/s00776-011-0122-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 06/10/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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Rasool F, Dasgupta K. Close the Tap. Headache 2012; 52:825-6. [DOI: 10.1111/j.1526-4610.2012.02111.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hagino T, Ochiai S, Watanabe Y, Senga S, Saito M, Naganuma H, Sato E, Haro H. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report. J Med Case Rep 2012; 6:75. [PMID: 22394604 PMCID: PMC3310800 DOI: 10.1186/1752-1947-6-75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 03/06/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.
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Affiliation(s)
- Tetsuo Hagino
- The Sports Medicine and Knee Center, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi 400-8533, Japan.
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Bilateral interhemispheric subdural hematoma after inadvertent lumbar puncture in a parturient. Can J Anaesth 2012; 59:389-93. [DOI: 10.1007/s12630-011-9664-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022] Open
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25
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Active cerebrospinal fluid leakage after resolution of postdural puncture headache. J Anesth 2011; 26:318-9. [DOI: 10.1007/s00540-011-1291-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/09/2011] [Indexed: 10/15/2022]
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26
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Mathew RM, Rosenfeld MR. Neurologic Complications of Bone Marrow and Stem-cell Transplantation in Patients with Cancer. Curr Treat Options Neurol 2011; 9:308-14. [PMID: 17580010 DOI: 10.1007/s11940-007-0016-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transplantation of bone marrow or peripheral blood stem cells is increasingly being used to treat a variety of oncologic disorders. These procedures are associated with a large spectrum of neurologic complications that significantly contribute to patient morbidity and mortality. These complications may arise at any time during and after the transplantation process and are particularly common in patients requiring chronic immunosuppression. The most frequent complications are infections and cerebrovascular or metabolic events, and toxicity from radiation or chemotherapy. Because of the unique circumstances and treatments involved in each step of the transplantation process, there is a higher incidence of some neurologic complications during discrete time periods, and an awareness of the temporal relationship of the neurologic disorder to the transplantation process facilitates diagnosis. With the exception of post-transplant lymphoproliferative disorder, in which reduced immunosuppression may be an effective therapeutic strategy, therapies are often the same as in the nontransplant patient. Complications of therapy can arise because of the presence of multiple comorbidities and medication interactions. Anticipation of common opportunistic infections and appropriate use of prophylactic medications can significantly reduce the incidence of infectious complications.
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Affiliation(s)
- Rose Marie Mathew
- Myrna R. Rosenfeld, MD, PhD Penn Neurological Institute, University of Pennsylvania Medical Center, 2 Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Khasawneh FA, Smalligan RD, Mohamad TN, Moughrabieh MK, Soubani AO. Lumbar puncture for suspected meningitis after intensive care unit admission is likely to change management. Hosp Pract (1995) 2011; 39:141-5. [PMID: 21441769 DOI: 10.3810/hp.2011.02.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The aim of this study was to determine the outcome of lumbar punctures (LPs) in critically ill medical patients and how likely the results were to change case management. MATERIALS AND METHODS A retrospective review was conducted on the medical records of all 168 patients who underwent LP during their medical intensive care unit (MICU) admission at a university hospital during a 4.5-year period beginning in January 2000. RESULTS Lumbar puncture was performed a mean of 2.8 days after MICU admission. The most common symptoms that prompted LP were changes in mental status and fever. Seventy-four percent of patients were on antibiotics at the time of LP, and 98% of patients had a computed tomography scan of the head performed before the procedure. Lumbar puncture confirmed meningitis in 47 (30%) patients and provided a specific bacteriologic diagnosis in 5 (3%) patients. The results of the procedure led to a change in management in 50 (30%) patients. The presence of meningeal signs and use of antibiotics at the time of the procedure were the factors that predicted change in management. CONCLUSION Although the likelihood that LP will yield a specific bacteriologic diagnosis in critically ill patients is low, the procedure frequently provides important information that can lead to a change in case management, most commonly de-escalation of antibiotic therapy.
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Affiliation(s)
- Faisal A Khasawneh
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA.
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Magro E, Remy-Neris O, Seizeur R, Allano V, Quinio B, Dam-Hieu P. Bilateral Subdural Hematoma Following Implantation of Intrathecal Drug Delivery Device. Neuromodulation 2011; 14:179-81; discussion 182. [DOI: 10.1111/j.1525-1403.2011.00335.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Iizuka Y, Sanui M, Ishioka H, Shiotsuka J, Otsuka Y, Murayama T, Lefor A. Intracranial hemorrhage associated with cerebrospinal fluid drainage during thoraco-abdominal aortic surgery. J Anesth 2010; 24:603-6. [PMID: 20422232 DOI: 10.1007/s00540-010-0947-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 04/01/2010] [Indexed: 11/25/2022]
Abstract
A 69-year-old woman underwent thoraco-abdominal aortic aneurysm repair with cerebrospinal fluid drainage (CSFD). The initial CSF pressure was elevated to approximately 25 cmH(2)O, and clear CSF was continuously drained at a rate of 30 ml/h with the drainage level at 10-20 cmH(2)O. The CSF became bloody when cardiopulmonary bypass was terminated. The total volume of CSF drained was approximately 300 ml at the conclusion of the 638 min operation. Three hours later, she suffered a series of generalized seizures because of intracranial hemorrhage (ICH). It was suggested that excessive drainage of CSF was associated with ICH. Meticulous control of drainage volume combined with standard pressure-based management may be the key to avoiding these complications.
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Affiliation(s)
- Yusuke Iizuka
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
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Troester MM. "She is fine, other than her spinal epidural!". Semin Pediatr Neurol 2010; 17:65-7. [PMID: 20434701 DOI: 10.1016/j.spen.2010.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Matthew M Troester
- Children's Health Centers, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
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Ng WH, Drake JM. Symptomatic spinal epidural CSF collection after lumbar puncture in a young adult: case report and review of literature. Childs Nerv Syst 2010; 26:259-62. [PMID: 19898852 DOI: 10.1007/s00381-009-0998-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 09/03/2009] [Indexed: 11/29/2022]
Abstract
Lumbar puncture is a very common neurological diagnostic procedure which is associated with minimal risk. Epidural cerebrospinal fluid (CSF) collection can occur after puncture of the dura from extravasation of CSF from the thecal sac. On rare occasions, the epidural collection can be large enough to cause neurological dysfunction. The epidural fat has less fibrous stroma in children compared to adults, and it is postulated that this facilitates the dissection of CSF along epidural space. We report a rare case of a large symptomatic spinal epidural CSF collection shortly after lumbar puncture presenting with severe leg pain. The patient recovered fully within 48 h with bed rest and analgesia, and repeat imaging 1 month later showed good resolution of the epidural collection. Review of the literature revealed that epidural CSF collections resolve with conservative measures without the need for surgical intervention even in the setting of significant neurological symptomatology.
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Affiliation(s)
- Wai H Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore
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Abstract
Lumbar puncture is a common procedure in the emergency department. Cerebrospinal fluid (CSF) leak through a dural tear can cause transient side effects including headache and backache, although more severe symptoms may occur. These CSF collections can be managed nonoperatively without any neurologic sequelae. We report a patient with a symptomatic epidural CSF collection after diagnostic lumbar puncture, followed by a brief review of the literature including discussion of techniques that can reduce CSF leak.
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Ben-Nakhi A, Muttikkal TJE, Ashebu SD, Keluth Chavan VN. Bilateral subdural hemorrhage following lumbar puncture in a case of suspected meningitis. A case report. Neuroradiol J 2008; 21:178-82. [PMID: 24256823 DOI: 10.1177/197140090802100204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 10/14/2007] [Indexed: 11/16/2022] Open
Abstract
Intracranial subdural hemorrhage is a rare complication of lumbar puncture. Caudal traction and tear of the subdural veins due to negative pressure caused by leakage of cerebrospinal fluid (CSF) following lumbar puncture (LP) is the mechanism. Prolonged headache or neurological symptoms following LP should warrant cross-sectional imaging to rule out subdural hemorrhage as it can be fatal. We report a case of subdural hemorrhage following LP in a patient with suspected meningitis and communicating hydrocephalus.
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Affiliation(s)
- A Ben-Nakhi
- Department of Radiology; Mubarak Al Kabeer Hospital; Kuwait -
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35
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Trunet S, Litré C, Tran H, Marnet D, Rousseaux P. Hypotension intracrânienne sévère associée à un hématome sous-dural à la suite d’une ponction lombaire diagnostique : cas clinique. Neurochirurgie 2008; 54:85-8. [DOI: 10.1016/j.neuchi.2007.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 12/24/2007] [Indexed: 11/17/2022]
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Lumbar puncture and subdural hygroma and hematomas in hematopoietic cell transplant patients. Bone Marrow Transplant 2008; 41:791-5. [PMID: 18246118 DOI: 10.1038/sj.bmt.1705971] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We reviewed records of hematopoietic cell transplantation (HCT) patients seen over the past 10 years who had head scan documentation of subdural fluid collections. A total of 17 patients were identified: 13 with allogeneic and 4 with autologous HCT (0.71% of allogeneic and 0.13% of autologous HCT patients seen in this time interval). Although less than 20% of HCT patients have lumbar puncture, 8 of the 17 subdural patients had lumbar puncture. The lumbar puncture was done 5-112 days (median 46 days) before subdural detection. Acute lymphocytic leukemia was the diagnosis in five of these eight; whereas, either acute myelogenous leukemia or myelodysplasia was the diagnosis in seven of the nine patients without lumbar puncture. In the patient group with lumbar puncture, subdurals were diagnosed earlier after HCT (median 25 days versus 5 months in the patient group without lumbar puncture) and were more often hygromas (37.5 versus 0%). These results support the suggestion of lumbar puncture or intrathecal therapy as a risk factor for subdurals. The presumptive mechanism involves lumbar cerebrospinal leak, low intracranial pressure, downward displacement of the brain, cerebrospinal fluid accumulation into the inner dural layers of the cerebral convexities (hygromas) and bleeding into these fluid collections (hematomas).
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37
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Boran P, Tokuc G, Boran BO, Oktem S. Intracerebral hematoma as a complication of intrathecal methotrexate administration. Pediatr Blood Cancer 2008; 50:152-4. [PMID: 16615061 DOI: 10.1002/pbc.20861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neurotoxicity of methotrexate is a well-documented issue, but development of an intracerebral hematoma following administration of intrathecal methotrexate is an extremely rare entity. A 6-year-old male with the diagnosis of non-Hodgkin lymphoma was put on a treatment regimen, including intrathecal methotrexate. Six days following the last intrathecal methotrexate administration, the patient developed a deteriorating state of consciousness. There was no history of trauma. Coagulation studies and platelet count were normal. Magnetic resonance imaging of the brain demonstrated a large left frontoparietal hematoma. Intracerebral hematoma may be a very rare, but serious, complication of intrathecal methotrexate administration.
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Affiliation(s)
- Perran Boran
- Dr. Lutfi Kirdar Kartal Research and Training Hospital, 2nd Clinic of Pediatrics, Istanbul, Turkey.
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38
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Newman MJ, Cyna AM. Immediate management of inadvertent dural puncture during insertion of a labour epidural: a survey of Australian obstetric anaesthetists. Anaesth Intensive Care 2008; 36:96-101. [PMID: 18326140 DOI: 10.1177/0310057x0803600117] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. Following dural puncture, 265 respondents (64%) indicated that they "would usually remove the Tuohy needle and resite". The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n = 236, 89%), in particular, the risk of misuse (n = 182, 70%). The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
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Affiliation(s)
- M J Newman
- Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Subramaniam B, Panzica PJ, Pawlowski JB, Ramanavarapu V, Pomposelli FB, De La Torre R, Lerner AB. Epidural Blood Patch for Acute Subdural Hematoma After Spinal Catheter Drainage During Hybrid Thoracoabdominal Aneurysm Repair. J Cardiothorac Vasc Anesth 2007; 21:704-8. [PMID: 17905278 DOI: 10.1053/j.jvca.2006.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Indexed: 11/11/2022]
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40
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Abel TJ, Chowdhary A, Gabikian P, Ojemann JG, Ellenbogen RG, Avellino AM. Spontaneous subdural fluid collections following transection of a fatty filum terminale: case report and review of the literature. Pediatr Neurosurg 2007; 43:507-11. [PMID: 17992042 DOI: 10.1159/000108797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 10/01/2006] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Taylor J Abel
- Department of Neurological Surgery, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, WA 98105, USA
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41
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Amini A, Liu JK, Kan P, Brockmeyer DL. Cerebrospinal fluid dissecting into spinal epidural space after lumbar puncture causing cauda equina syndrome: review of literature and illustrative case. Childs Nerv Syst 2006; 22:1639-41. [PMID: 16933137 DOI: 10.1007/s00381-006-0204-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Indexed: 11/28/2022]
Abstract
OBJECTS We report a case of epidural cerebrospinal fluid (CSF) leak after lumbar puncture caused by CSF dissecting into the spinal epidural space. The incidence of this phenomenon may be higher than suspected, although most cases may remain asymptomatic. MATERIALS AND METHODS A 4-year-old girl with new-onset seizure underwent a diagnostic lumbar puncture, the results of which were normal; 3 h later, she began experiencing severe low-pressure headaches and lower back pain, bilateral lower extremity weakness, numbness, and pain, and urinary retention when upright. Spinal MRI demonstrated extensive epidural CSF collection posterior to the thecal sac extending from the cervicothoracic junction to the sacrum. After 48 h in the supine position and gradual mobilization, the patient had complete resolution of symptoms and no neurological sequelae. CONCLUSION Patients usually recover without any neurological deficits after conservative treatment. Prone or lateral decubitus positioning immediately after lumbar puncture may decrease the incidence of this phenomenon.
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Affiliation(s)
- Amin Amini
- Division of Pediatric Neurosurgery, Primary Children's Medical Center, 100 North Medical Drive, Salt Lake, UT 84113, USA
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Yildirim GB, Colakoglu S, Atakan TY, Büyükkirli H. Intracranial subdural hematoma after spinal anesthesia. Int J Obstet Anesth 2005; 14:159-62. [PMID: 15795150 DOI: 10.1016/j.ijoa.2004.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Revised: 06/01/2004] [Accepted: 08/13/2004] [Indexed: 11/25/2022]
Abstract
Intracranial subdural hematoma is an exceptionally rare but life-threatening complication of spinal anesthesia. We report a case of intracranial subdural hematoma following spinal anesthesia for cesarean section in a 27-year-old woman. She developed a diffuse headache after surgery with a blood pressure of 220/140 mm Hg which was followed by generalized seizure activity. Her blood pressure remained high after medication with diazepam, nifedipine and magnesium sulfate. She remained unconscious with a Glasgow coma scale of 5. The cranial tomography revealed a subdural hematoma with diffuse cerebral edema and cerebral tentorial herniation. When a patient complains of postdural puncture headache and then has seizure activity, one should consider alternative diagnoses, including that of a subdural hematoma, and carry out a careful examination, including magnetic resonance imaging or computerized tomography scan.
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Affiliation(s)
- G Berkel Yildirim
- Department of Anesthesiology and Intensive Care, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
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44
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45
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Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Pract Res Clin Anaesthesiol 2003; 17:451-69. [PMID: 14529014 DOI: 10.1016/s1521-6896(03)00033-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Post-dural puncture headache (PDPHA) has been a vexing problem for patients undergoing dural puncture for spinal anaesthesia, as a complication of epidural anaesthesia, and after diagnostic lumbar puncture since Bier reported the first case in 1898. This Chapter discusses the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural spaces. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPHA than traditional cutting point needle tips (Quincke-point needles). A careful history can rule out other causes of headache. A positional component of headache is the sine qua non of PDPHA. In high-risk patients (e.g. age < 50 years, post-partum, large-gauge-needle puncture), patients should be offered early (within 24-48 h of dural puncture) epidural blood patch. The optimum volume of blood has been shown to be 12-20 ml for adult patients. Complications of autologous epidural blood patch are rare.
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Affiliation(s)
- Kenneth D Candido
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Lecouvet FE, Annet L, Duprez TP, Cosnard G, Scordidis V, Malghem J. Uncommon magnetic resonance imaging observation of lumbar subdural hematoma with cranial origin. J Comput Assist Tomogr 2003; 27:530-3. [PMID: 12886137 DOI: 10.1097/00004728-200307000-00013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A patient with a history of pain, paresthesias, and weakness in both legs is reported. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated subacute subdural hematoma. Brain MRI obtained 1 day later because of progressive headache showed hemorrhagic cortical metastasis and extensive subdural hematoma. It is hypothesized that the lumbar hematoma originated from the intracranial bleeding, which was substantiated by the observation of a thin hemorrhagic collection connecting cranial and lumbar hematomas on MRI. Cranial origin should be included in the differential diagnosis of spontaneous spinal subdural hematomas.
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Affiliation(s)
- Frédéric E Lecouvet
- Department of Medical Imaging, Saint Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue 10/2942B, 1200 Brussels, Belgium.
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de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CAJ. Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003; 74:752-5. [PMID: 12754345 PMCID: PMC1738487 DOI: 10.1136/jnnp.74.6.752] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Spontaneous intracranial hypotension (SIH) is characterised by postural headache and low opening pressure at lumbar puncture without obvious cause. Cranial magnetic resonance imaging often shows small subdural collections without mass effect, dural enhancement, venous sinus dilatation, or downward displacement of the brain. The condition is thought to be benign. OBJECTIVES To evaluate the incidence of subdural haematoma as a serious complication of SIH. METHODS A prospective survey of all cases of SIH presenting to a large neuroscience unit over a two year period. RESULTS Nine cases of SIH were seen. Four of these were complicated by acute clinical deterioration with reduced conscious level because of large subdural haematomas requiring urgent neurosurgical drainage. CONCLUSIONS SIH should not be considered a benign condition. Acute deterioration of patients' clinical status may occur secondary to large subdural haematomas, requiring urgent neurosurgical intervention.
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Affiliation(s)
- R J de Noronha
- Department of Radiology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
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Blanloeil Y, Chabbert C, Lehot JJ. [Subdural haematoma after cerebral fluid hypotension: an unknown complication to diagnose and treat]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:275-7. [PMID: 12818317 DOI: 10.1016/s0750-7658(03)00096-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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van den Berg JSP. Subdural hygroma: a rare complication of spinal anesthesia diagnosed after a grand mal convulsion. Anesth Analg 2003; 96:907. [PMID: 12598285 DOI: 10.1213/01.ane.0000039466.58263.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ezri T, Abouleish E, Lee C, Evron S. Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome. Can J Anaesth 2002; 49:820-3. [PMID: 12374711 DOI: 10.1007/bf03017415] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour. CLINICAL FEATURES This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000 x microL-1) who subsequently developed the syndrome of hemolysis, elevated liver enzymes and low platelets. On the first postoperative day, postdural puncture headache (PDPH) developed. An epidural blood patch (EBP) was deferred to the third postoperative day because of a platelet count of 21,000 x micro L-1. However, the headache intensified from a typical PDPH to one which was not posturally related. A second EBP was abandoned after the injection of 5 mL of blood because of increasing headache during the procedure. Magnetic resonance imaging revealed bilateral temporal subdural hematomas. The patient was managed conservatively and discharged home without any sequelae. CONCLUSION It is conceivable that thrombocytopenia together with possible abnormal platelet function increased the risk of subdural hematoma. Alternative diagnoses to PDPH should be considered whenever headache is not posturally related.
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Affiliation(s)
- Tiberiu Ezri
- Department of Anesthesiology, Wolfson Medical Center, Holon, Israel.
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