From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.
Anesth Analg. 2015 Mar;120(3):644-646. doi: 10.1213/ANE.0000000000000587.
In this article, we provide a literature review of cranial nerve (CN) VI injury after dural-arachnoid puncture. CN VI injury is rare and ranges in severity from diplopia to complete lateral rectus palsy with deviated gaze. The proposed mechanism of injury is cerebrospinal fluid leakage causing intracranial hypotension and downward displacement of the brainstem. This results in traction on CN VI leading to stretch and neural demyelination. Symptoms may present 1 day to 3 weeks after dural-arachnoid puncture and typically are associated with a postdural puncture (spinal) headache. Resolution of symptoms may take weeks to months. Use of small-gauge, noncutting spinal needles may decrease the risk of intracranial hypotension and subsequent CN VI injury. When ocular symptoms are present, early administration of an epidural blood patch may decrease morbidity or prevent progression of ocular symptoms.
本文对硬脑膜-蛛网膜穿刺后颅神经 (CN) VI 损伤进行文献回顾。CN VI 损伤罕见，严重程度从复视到完全外直肌瘫痪伴眼球偏斜不等。损伤的机制是脑脊液漏导致颅内压降低和脑干向下移位，从而牵拉 CN VI，导致拉伸和神经脱髓鞘。症状可在硬脑膜-蛛网膜穿刺后 1 天至 3 周出现，通常与穿刺后头痛（脊髓）相关。症状的缓解可能需要数周至数月。使用小口径、非切割的脊髓针可能会降低颅内压降低和随后的 CN VI 损伤的风险。当出现眼部症状时，早期行硬膜外血贴可能会降低发病率或防止眼部症状进展。
