Strauss Lauren, Loder Elizabeth, Rizzoli Paul
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Faulkner Hospital, Boston, MA, USA.
Headache. 2014 Nov-Dec;54(10):1651-5. doi: 10.1111/head.12403. Epub 2014 Jun 10.
Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block.
枕神经阻滞常用于治疗多种头痛综合征，一般认为其安全且耐受性良好。我们报告一例24岁健康女性病例，该患者左侧枕部、顶叶和颞部出现锁定性疼痛，被诊断为可能的枕神经痛。在用布比卡因和曲安奈德溶液阻滞左侧枕大神经和枕小神经后数分钟内，她出现了完全性左侧面神经麻痹。钆增强脑磁共振成像未显示异常，4 - 5小时后症状完全缓解。麻醉溶液沿组织平面意外扩散似乎是这一不良事件最可能的解释。面神经走行异常或面神经与枕神经之间的连接异常可能也起了作用，同时患者的俯卧位以及使用相对大量强效麻醉剂也可能有影响。临床医生应意识到暂时性面神经麻痹是枕神经阻滞可能的并发症。
