1/21. Chronic subdural haematoma following caesarean section under spinal anaesthesia.Intracranial subdural haematoma is a rare complication of spinal anaesthesia. This report describes the case of a 31-year-old woman who presented with post partum headache following spinal anaesthesia for caesarean section. Bilateral haematomata were evacuated via burr-holes performed under total intravenous anaesthesia and the patient made a complete and uneventful recovery. The recognized causes of subdural haematoma are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/21. Successful epidural blood patch in a patient with headache for 6 months after lumbar root decompression.Prolonged headache following dural puncture is an uncommon problem that may occur after a spinal tap, often as a complication of epidural anaesthesia. This problem has also been described after long-term epidural or spinal anaesthesia, myelography or spinal surgery. A case of prolonged postdural puncture headache following lumbar nerve root decompression is described in a healthy young man. No other cause could be found either clinically or with the aid of scanning by computerized tomography or magnetic resonance imaging techniques at the spinal level involved. The symptoms were successfully treated with an epidural blood patch performed seven months following the original surgical operation.- - - - - - - - - - ranking = 0.28571428571429keywords = anaesthesia (Clic here for more details about this article) |
3/21. Cranial subdural haematoma after spinal anaesthesia.Intracranial subdural haematoma is an exceptionally rare complication of spinal anaesthesia. A 20-yr-old male underwent appendicectomy under partial spinal and subsequent general anaesthesia. A week later, he presented with severe headache and vomiting not responding to bed rest and analgesia. magnetic resonance imaging showed a small acute subdural haematoma in the right temporo-occipital region. The patient improved without surgical decompression. The pathogenesis of headache and subdural haematoma formation after dural puncture is discussed and the literature briefly reviewed. Severe and prolonged post-dural puncture headache should be regarded as a warning sign of an intracranial complication.- - - - - - - - - - ranking = 0.85714285714286keywords = anaesthesia (Clic here for more details about this article) |
4/21. Recurrent post-partum seizures after epidural blood patch.There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
5/21. Epidural blood patch for post dural puncture headache: a handy ally [corrected].BACKGROUND: Epidural blood patch is a well-known item in the management protocol of post dural puncture headache though never been practised or reported in our environment. The aim of this report is to document its efficacy and establish a rationale for its use. METHOD: A review of the case record of patients with post dural puncture headache and the relevant literature. RESULT: A case of post dural puncture headache was encountered at a free medical missionary outreach program following spinal anaesthesia for myomectomy. Having exhausted all the available conservative management options, she was offered epidural blood patch. The recovery profile was collected by assessment of her abilities and disabilities before and after the epidural blood patch, with visual analog scale for pain. The clinical condition improved a lot, with remarkable improvement in neck movement and the visual analog scale. CONCLUSION: We conclude that epidural blood patch is a superior therapy for post dural puncture headache and recommend that post-anaesthetic rounds be conducted routinely to identify complications and enable early institution of therapy.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
6/21. Acute subdural haematoma after accidental dural puncture during epidural anaesthesia.A case is reported of acute intracranial subdural haematoma following accidental dural puncture during epidural anaesthesia. A 36-year-old primigravida with a gestation of 37 weeks and 3 days underwent caesarean section for which epidural anaesthesia was initially planned. An 18-gauge Tuohy needle was inserted into the L3-4 interspace but accidental dural puncture occurred. The needle was removed and general anaesthesia was initiated for surgery. On the second day post partum, the patient described a headache in both occipital area and neck that was relieved by lying down. On the seventh post-partum day she suffered tonic-clonic convulsions and underwent computerised tomography (CT). Despite different analgesic treatments and a normal CT, the patient suffered severe headaches in the following days. magnetic resonance imaging revealed a 4-mm subdural hematoma in the right frontal area. The persisting headache decreased on day 12 and disappeared on day 14. The patient was discharged from hospital on day 15. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anaesthesia should prompt the anaesthetist to consider the existence of intracranial complications and to seek immediate clinical and radiological diagnosis.- - - - - - - - - - ranking = 1.1428571428571keywords = anaesthesia (Clic here for more details about this article) |
7/21. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.57142857142857keywords = anaesthesia (Clic here for more details about this article) |
8/21. Cerebral venous thrombosis initially considered as a complication of spinal-epidural anaesthesia.Cerebral venous thrombosis is an unusual condition characterized by headache, nausea, vomiting, focal deficits and epileptic seizures. In this case report we describe a patient who presented with headache and focal motor deficits after an uneventful Caesarean section, performed using combined spinal-epidural anaesthesia. magnetic resonance imaging was performed because of the pronounced neurological symptoms, and a diagnosis of cerebral venous thrombosis was made. The patient was treated with anticoagulant agents and made a complete recovery. This case emphasizes the importance of considering cerebral venous thrombosis in the differential diagnosis of headache in the post-partum period prior to instituting conventional therapy.- - - - - - - - - - ranking = 0.71428571428571keywords = anaesthesia (Clic here for more details about this article) |
9/21. Proposal for a standardized protocol for the systematic orofacial examination of patients with Hereditary Sensory Radicular Neuropathy.AIM: To apply a standardized protocol for the orofacial evaluation of two adult siblings (one male and one female) with Hereditary Sensory Radicular Neuropathy (HSRN) that presented with dental problems. SUMMARY: The systematic evaluation consisted of (a) clinical questionnaire; (b) radiographs [orthopantomography and computarized tomography (CT)]; (c) orofacial psychophysical tests (pain, thermal, mechanical and electrical sensation); and (d) histology of gingiva and pulp (optical and transmission electronic microscopy). The female patient had complete insensitivity to orofacial pain and partial facial heat sensitivity, and received dental treatment without anaesthesia or pain. She had a severe and painless jaw infection due to pulp necrosis in tooth 37. The male patient had partial insensitivity to orofacial pain and required anaesthesia for dental treatment. Histological examination of gingivae and pulpal tissue revealed an altered proportion of unmyelinated and myelinated sensory nerve fibres. KEY learning POINTS: * patients with HSRN may present with significant, silent dental disease. * A standard protocol is helpful when evaluating such patients. * If the opportunity arises, evaluation of pulp tissue may reveal an altered proportion of myelinated and unmyelinated nerve fibres. This may avoid the more estabilished sural nerve biopsy.- - - - - - - - - - ranking = 0.28571428571429keywords = anaesthesia (Clic here for more details about this article) |
10/21. pneumocephalus following attempted epidural anaesthesia.This report describes iatrogenic pneumocephalus in an obstetrical patient following attempted epidural anaesthesia using the loss of resistance technique. On the fourth attempt at epidural injection, an apparent loss of resistance was identified and 5 ml air was injected. The patient complained immediately of severe bifrontal headache followed by emesis. The baby was eventually delivered by Caesarean section, with general anaesthesia and avoiding nitrous oxide. The patient's headache resolved within 24 hr without further sequelae.- - - - - - - - - - ranking = 0.85714285714286keywords = anaesthesia (Clic here for more details about this article) |
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