Sghirlanzoni A, Gemma M, Pareyson D, Cimino C, Boiardi A
Department of Neurology, Istituto Neurologico C. Besta, Milano, Italy.
Anaesthesia. 1989 Oct;44(10):831-3. doi: 10.1111/j.1365-2044.1989.tb09101.x.
A 62-year-old male suddenly developed a severe paraparesis after epidural anaesthesia. He recovered gradually over the next few months. He had an acute relapse one year later and a selective spinal angiography showed a dural T8 arteriovenous fistula with large draining veins. Intravascular embolisation of the fistula produced immediate and sustained clinical improvement. The mechanism commonly held responsible for neurological disturbances in spinal dural arteriovenous fistulas is cord hypoxia secondary to venous hypertension. The 20-ml of local anaesthetic solution injected into a narrow spinal canal with osteophytosis may have caused further venous engorgement, cord hypoxia and acute neurological deficit.
一名62岁男性在硬膜外麻醉后突然出现严重的双下肢轻瘫。在接下来的几个月里逐渐康复。一年后急性复发，选择性脊髓血管造影显示T8节段硬脊膜动静脉瘘伴粗大引流静脉。瘘管的血管内栓塞使临床症状立即并持续改善。通常认为脊髓硬脊膜动静脉瘘导致神经功能障碍的机制是静脉高压继发脊髓缺氧。注入狭窄且伴有骨赘形成的椎管内的20毫升局部麻醉溶液可能进一步导致静脉充血、脊髓缺氧和急性神经功能缺损。
