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一名患有未确诊转移性脊柱肿瘤的患者在脊髓麻醉后发生截瘫。

Paraplegia following spinal anesthesia in a patient with an undiagnosed metastatic spinal tumor.

作者信息

Cherng Yih-Giun, Chen I-Yen, Liu Feng-Lin, Wang Mao-Hsien

机构信息

Department of Anesthesiology, Wan-Fang Medical Center, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.

出版信息

Acta Anaesthesiol Taiwan. 2008 Jun;46(2):86-90. doi: 10.1016/S1875-4597(08)60033-8.

Abstract

Although extremely rare, paraplegia can be a complication following spinal anesthesia if the patient has a previously unrecognized spinal tumor. We describe a 75-year-old male patient who underwent retrograde ureteroscopic examination under spinal anesthesia. He developed complete paraplegia 24 hours later. Magnetic resonance imaging (MRI) revealed bone metastasis to T10, a vertebral body mass lesion at L3, and an epidural mass at T9-11 with cord compression. The aim of this case report is to highlight the importance of neurological examination of patients undergoing neuraxial block both in the pre-anesthetic interview and postoperative examination in the recovery period. Careful observation of the postoperative course is essential to exclude any possible neurological complications. If motor and sensory functions do not satisfactorily recover, an MRI examination should be undertaken without delay to determine whether the underlying pathology is treatable or reversible.

摘要

虽然极为罕见,但如果患者之前存在未被识别的脊柱肿瘤,截瘫可能是脊髓麻醉后的一种并发症。我们描述了一名75岁男性患者,他在脊髓麻醉下接受了逆行输尿管镜检查。24小时后他出现了完全性截瘫。磁共振成像(MRI)显示T10椎体有骨转移、L3椎体有肿块病变以及T9 - 11节段有硬膜外肿块并伴有脊髓受压。本病例报告的目的是强调在麻醉前访视和恢复期术后检查中,对接受神经轴阻滞患者进行神经学检查的重要性。仔细观察术后病程对于排除任何可能的神经并发症至关重要。如果运动和感觉功能未能令人满意地恢复,应立即进行MRI检查以确定潜在病变是否可治疗或可逆。

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