Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, Michigan, USA.
J Neuroophthalmol. 2013 Jun;33(2):106-12. doi: 10.1097/WNO.0b013e318273bff4.
Diplopia that occurs after an epidural spinal catheter has been placed for pain control has been attributed to sixth nerve palsy nerve palsy induced by intracranial hypotension. There is sparse information about the factors that confound diagnosis in this setting.
Review of 6 cases examined over a period of 5 years at a single tertiary care medical center.
Six confounders to diagnosis were identified: 1) lack of awareness that an epidural spinal catheter was or had been in place; 2) delayed reporting of diplopia; 3) mild or inapparent ductional deficits; 4) lack of postural headache; 5) clinical features that suggested an alternative diagnosis; 6) neuroimaging features that did not allow exclusion of pachymeningitis.
Clinicians should be aware of features that confound a diagnosis of dural puncture-induced intracranial hypotension as a cause of diplopia in the post-operative period when an epidural pain control system is or has been deployed. If these confounders are recognized and the correct diagnosis is reached, radiologists will be less likely to diagnose pachymeningitis and clinicians will be able to avoid lumbar puncture, which may exacerbate the condition.
硬膜外脊髓导管用于疼痛控制后发生的复视归因于颅内低血压引起的第六神经麻痹。在这种情况下，关于混淆诊断的因素的信息很少。
在一家三级医疗中心的 5 年内对 6 例进行了回顾。
确定了 6 个诊断混淆因素：1）不知道硬膜外脊髓导管是否存在或已存在；2）复视报告延迟；3）轻度或不明显的牵引缺陷；4）无体位性头痛；5）提示其他诊断的临床特征；6）影像学特征不排除硬脑膜炎。
当硬膜外疼痛控制系统存在或已经部署时，临床医生应注意在术后时期诊断硬膜穿刺引起的颅内低血压引起的复视时可能混淆诊断的特征。如果认识到这些混淆因素并做出正确的诊断，放射科医生就不太可能诊断为硬脑膜炎，临床医生也可以避免腰椎穿刺，这可能会使病情恶化。
