1/10. 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 = 1keywords = anaesthesia (Clic here for more details about this article) |
2/10. Spontaneous spinal epidural abscess in a neonate. With a review of the literature.Spinal epidural abscess is uncommon in neonates and infants, and is usually related to previous lumbar puncture or epidural anaesthesia. diagnosis is often delayed because of the non-specific presentation. We present a 7-week-old girl who developed paraplegia 3 weeks after transient fever and a self-limiting skin rash. MR imaging revealed an epidural contrast-enhancing lesion compressing the spinal cord. At operation, an organised granulated abscess was identified with staphylococcus aureus the causative organism. laminectomy and removal of the organised abscess and systemic intravenous antibiotics resulted in complete neurological recovery. The patient did not develop late spinal deformity following the decompressive laminectomy. The rapid onset of paraplegia can often be missed in such a young child but should be promptly investigated, as surgical treatment of cord compression carries an excellent prognosis for neurological recovery. We review the literature on the initial presentation, usual investigations, causative organisms and surgical management of paediatric spinal epidural abscesses.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/10. paraplegia associated with combined spinal-epidural anaesthesia caused by preoperatively unrecognized spinal vertebral metastasis.We describe a case of paraplegia following combined spinal-epidural anaesthesia. It was postoperatively determined that a tumour of the vertebrae which was compressing the spinal cord was responsible for this complication. We suggest that the pre-existing pathology of the spine must be borne in mind as a differential diagnosis of acute postoperative paraplegia.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
4/10. Congenital neuroblastoma with paraplegia. Case report.A case of congenital neuroblastoma presenting with paraplegia in a newborn baby is described. The tumor was removed and chemotherapy was given. The child is now 2 years old, without relapse, but still suffers from flaccid paralysis and anaesthesia of both legs.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/10. Spinal subdural haematoma: how relevant is the INR?STUDY DESIGN: Case report. OBJECTIVE: To report a rare cause of spinal cord compression. SETTING: University Hospital, wales, UK. CASE REPORT: A 67-year-old gentleman on oral anticoagulation for atrial fibrillation presented with a 4-h history of progressive loss of sensation and weakness in both legs; there was no history of trauma. On examination, he had a flaccid paraplegia with altered sensation in the L1,2,3 dermatomes and complete anaesthesia in the L4,5 distribution. knee and ankle jerk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anterior canal between T10 and L3. The patient had an uneventful postoperative course generally, but at 1 week there was no neurological recovery. CONCLUSION: This case highlights that anticoagulation even when well controlled is not without risk. This is particularly of concern as the number of patients receiving long-term anticoagulation therapy has doubled between 1993 and 1998.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
6/10. Spondyloepiphyseal dysplasia congenita. Caesarean section under epidural anaesthesia.Spondyloepiphyseal dysplasia congenita is a rare condition with several features of concern to the anaesthetist. The patients are of extremely short stature and the presence of kyphoscoliosis may lead to significant respiratory impairment. Cervical vertebral body changes can result in spinal cord compression and laryngotracheal stenosis may be present. The management of such a patient presenting for elective Caesarean section under epidural anaesthesia is described.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
7/10. Spontaneous spinal subdural haematoma during general anaesthesia.Spontaneous spinal subdural haematoma causing acute spinal cord compression is a well recognized condition and often responds well to early surgical intervention. In the elderly, the haematoma usually occurs as a result of minor trauma or atherosclerosis with hypertension. We present in this report the history of a patient who became paraplegic during a general anaesthetic for an operation for removal of a ureteral calculus. rupture of a spinal vascular malformation was found to be responsible for the subdural haematoma, which remained undiagnosed until surgical exploration.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/10. Spinal epidural hematoma. Report of a case and review of the literature.We report the case of a thoracic epidural hematoma at the T7-T9 level which occurred after placement of spinal epidural catheter for continuous anaesthesia in acute pancreatitis. The male patient felt a sudden back pain after six days of successful analgesia and became paraplegic 24 hours afterwards. An emergency laminectomy and removal of the hematoma were performed; however, the patient recovered only incompletely. We discuss the clinical signs and symptoms of spinal epidural hematoma as well as its diagnostics and therapy. The controversial views from the literature concernings its etiology are critically reviewed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
9/10. A surgically placed epidural catheter in a patient with spinal trauma.PURPOSE: To report the successful perioperative anaesthetic and analgesic management of a spinal trauma patient with a surgically placed epidural catheter. CLINICAL FEATURES: A 15-yr-old adolescent woman sustained an unstable spinal column injury with an incomplete neurological deficit following a high speed motor vehicle accident. She was scheduled for spinal decompression and stabilisation through a left thoracoabdominal approach. Balanced general anaesthesia was undertaken. Prior to closure, a multi-orifice epidural catheter was surgically placed under direct vision 5 cm into the anterior epidural space. The catheter was then tunnelled out through the psoas muscle and secured in place. Combined epidural-general anaesthesia was then initiated for the duration of the case using 5 ml bupivacaine 0.25% after an initial test dose of 3 ml lidocaine 1.5% with epinephrine. An infusion of bupivacaine 0.10% and fentanyl 5 micrograms.ml-1 at 8 ml.hr-1 using patient controlled epidural analgesia (PCEA) provided excellent postoperative pain control for four days. She had an uncomplicated postoperative course. CONCLUSION: A surgically placed epidural catheter provided excellent, safe, perioperative anaesthesia and analgesia in this patient with unstable spinal trauma.- - - - - - - - - - ranking = 1.5keywords = anaesthesia (Clic here for more details about this article) |
10/10. Closed reduction of bilateral locked facets of the cervical spine under general anaesthesia.BACKGROUND: Bilateral facet interlocking of the cervical spine is a relatively uncommon type of cervical spinal injury. It is frequently associated with devastating neurological symptoms and signs. Early reduction of the locked facets is thought to be critical in preventing progressive secondary spinal cord injury. Whereas skull tong traction remains our primary option for closed reduction of bilateral locked facets of the cervical spine, it is not always successful, even with heavy traction weights. Other more aggressive measures may occasionally be required. The authors report their experience in reducing bilateral locked facets of the cervical spine by manual closed reduction. methods: This small series consists of six cases of cervical spinal injury with bilateral locked facets in which manual closed reduction under general anaethesia and muscle relaxation was used. Three of them presented with complete quadriplegia (Frankel class A). One case presented with incomplete but severe neurological deficits (Frankel class B). After unsuccessful closed reduction with skull traction, these patients were treated by manual closed reduction under general anaesthesia and muscle relaxation, followed by anterior discectomy, interbody fusion and stabilization. RESULTS: All cases made neurological improvement after the procedures. Even in cases with initial severe neurological deficits, the recovery was remarkable. The recovery was dramatic in two cases. Case 1 improved from Frankel class B to E; and Case 5 from Frankel class A to D. No case deteriorated neurologically after the procedures. pneumonia occurred in Case 3; and stress ulcer accompanied by haemorrhage was noted in Case 4. None of these complications was directly related to the procedures. CONCLUSION: The potential for improvement of neurological function following early and successful reduction and fixation of the dislocated spine is emphasized. With meticulous techniques, manual closed reduction may be an effective alternative to skull tong traction when the latter fails.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
| | Next -> |