1/34. Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation.A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/34. Nontraumatic acute spinal subdural hematoma: report of five cases and review of the literature.Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.- - - - - - - - - - ranking = 117.6055760523keywords = subdural (Clic here for more details about this article) |
3/34. Spinal cord injury following an attempted thoracic epidural.Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.- - - - - - - - - - ranking = 63.607454470999keywords = haematoma (Clic here for more details about this article) |
4/34. Complete paraplegia as a result of regional anesthesia.Complications after spinal or epidural anesthesia are rare. We report 2 cases of postoperative, complete paraplegia after regional anesthesia in orthopaedic patients not on anticoagulants. The paralysis was likely the result of spinal cord compression secondary to an epidural hematoma in 1 case and subdural hematoma in 1 case. A review of the literature regarding complications of regional anesthesia is presented. Regional anesthesia should be administered with caution and in selected patients.- - - - - - - - - - ranking = 16.8007965789keywords = subdural (Clic here for more details about this article) |
5/34. Lumbar ependymoma presenting with paraplegia following attempted spinal anaesthesia.Neurological deterioration from intraspinal haematoma following insertion of a spinal needle is extremely rare. We present the case of a 28-yr-old female, who presented with complete paraplegia following attempted spinal anaesthesia for delivery of her third child. Space-occupying iatrogenic spinal haemorrhage from a previously undiagnosed lumbar ependymoma was found to be the precipitating cause. Following laminotomy with blood clot and tumour removal her neurological function improved.- - - - - - - - - - ranking = 32.0537272355keywords = haematoma, haemorrhage (Clic here for more details about this article) |
6/34. Intraspinal oxidised cellulose (Surgicel) causing delayed paraplegia after thoracotomy--a report of three cases.Oxidised regenerated cellulose (Surgicel) is a commonly used haemostatic agent in neurosurgery, thoracic surgery, and orthopaedics. We present three cases of paraplegia after thoracic surgery during which oxidised cellulose had been used during thoracotomy for haemorrhage control, and was later found to have passed through the intervertebral foramen causing spinal cord compression. In all intraspinal and perispinal procedures, the over-liberal use of Surgicel should be avoided, and attempts made to remove all excess Surgicel once adequate haemostasis is obtained.- - - - - - - - - - ranking = 0.25keywords = haemorrhage (Clic here for more details about this article) |
7/34. Widespread post-traumatic acute spinal subdural haematoma: case report and review of the literature.STUDY DESIGN: A case report of acute post-traumatic spinal subdural haematoma (ASSH). OBJECTIVE: To report a rare post-traumatic problem. SETTING: Dicle University Hospital, Diyarbakir, turkey. METHOD: A 3-year-old boy was admitted to our clinic with paraplegia 24 h after falling from a height of about 5 meters. Investigation revealed an acute spinal subdural haematoma. RESULTS: Following surgery there was marked improvement. The rehabilitation of the patient continues. CONCLUSION: MRI is the most valuable diagnostic method. In each case diagnosed as ASSH, prompt evacuation should be performed before irreversible neurological damage occurs.- - - - - - - - - - ranking = 400.91455201364keywords = haematoma, subdural haematoma, subdural (Clic here for more details about this article) |
8/34. Delayed presentation of post-traumatic aneurysm of the posterior inferior cerebellar artery in a patient with spinal cord injury.STUDY DESIGN: A case report. OBJECTIVE: To present and discuss the case of a patient with serious head and spinal injuries who suffered delayed haemorrhage from a post-traumatic aneurysm of the right posterior inferior cerebellar artery following surgical treatment of vertebral fracture and hydrocephalus. SETTING: National spinal injuries Unit and Institute of Neurological Sciences, Southern General Hospital, Glasgow, scotland, UK. methods: Clinical and radiological follow-up of the patient. RESULTS: The aneurysm was treated by coil occlusion of the right vertebral artery. Post-operative films showed that the aneurysm had been successfully obliterated. CONCLUSION: Post-traumatic cerebral aneurysms are very rare. Neurosurgical and rehabilitation teams need to be aware of this late treatable sequela of head injury.- - - - - - - - - - ranking = 0.25keywords = haemorrhage (Clic here for more details about this article) |
9/34. paraplegia due to a ruptured aneurysm of the distal posterior inferior cerebellar artery.A case of paraplegia was due to a ruptured aneurysm of the distal posterior inferior cerebellar artery. The paraplegia was caused by a unilateral lesion located between the cervicomedullary junction and the C2 level, where it involved both crossed and uncrossed pyramidal fibres projecting to the lower extremities. Since a vascular lesion near the cervicomedullary junction is likely to be missed, special attention should be paid to this region when investigating subarachnoid haemorrhage with paraplegia.- - - - - - - - - - ranking = 0.25keywords = haemorrhage (Clic here for more details about this article) |
10/34. Subdural catheter migration may lead to baclofen pump dysfunction.OBJECTIVES: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. STUDY DESIGN: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. SETTING: Regional spinal cord injuries centre in Geneva (switzerland). methods: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. RESULTS: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. CONCLUSIONS: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.- - - - - - - - - - ranking = 16.8007965789keywords = subdural (Clic here for more details about this article) |
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