Oliveira Ricardo Paquete, Teixeira Mafalda, Cochito Sofia, Furtado Ana, Grima Bruno, Alves José Delgado
Serviço de Medicina IV, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa. Lisboa, Portugal.
Eur J Case Rep Intern Med. 2019 Dec 31;7(1):001334. doi: 10.12890/2019_001334. eCollection 2020.
Meningitis is a very uncommon complication of spinal anesthesia, and drug-induced aseptic meningitis (DIAM) is even rarer. We present two cases of DIAM following spinal anesthesia with bupivacaine and ropivacaine, respectively. The patients presented shortly after the procedure with typical meningitis symptoms. Since CSF (cerebrospinal fluid) analysis could not initially exclude bacterial meningitis, they were started on empirical antibiotics. CSF was subsequently found to be negative for viruses and bacteria in both cases, and antibiotics were promptly stopped. Both patients improved rapidly and without neurological sequelae. While it remains a diagnosis of exclusion, it is important to be aware of DIAM as recognition of the condition can lead to shorter admission times and avoid unnecessary use of antibiotics.
A diagnosis of DIAM should be considered when a patient who recently underwent spinal anesthesia is admitted with symptoms and CSF compatible with meningitis.Clinical and laboratory findings (including CSF analysis) cannot distinguish between bacterial meningitis and DIAM.A negative CSF culture and rapid recovery confirm the diagnosis and stopping antibiotics at this point is effective.
脑膜炎是脊髓麻醉一种非常罕见的并发症，药物性无菌性脑膜炎（DIAM）则更为罕见。我们分别报告了两例分别在布比卡因和罗哌卡因脊髓麻醉后发生DIAM的病例。患者在手术后不久出现典型的脑膜炎症状。由于脑脊液（CSF）分析最初无法排除细菌性脑膜炎，因此开始给予经验性抗生素治疗。随后发现两例患者的脑脊液病毒和细菌检测均为阴性，抗生素随即停用。两名患者均迅速康复且无神经后遗症。虽然DIAM仍然是一种排除性诊断，但认识到这种疾病很重要，因为识别该病症可缩短住院时间并避免不必要的抗生素使用。
当近期接受脊髓麻醉的患者因与脑膜炎相符的症状和脑脊液而入院时，应考虑DIAM的诊断。临床和实验室检查结果（包括脑脊液分析）无法区分细菌性脑膜炎和DIAM。脑脊液培养阴性和快速康复可确诊，此时停用抗生素有效。
