Department of Neurology, Neuroscience Institute, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA.
BMC Neurol. 2020 May 13;20(1):187. doi: 10.1186/s12883-020-01763-8.
Intrathecal injection is a rare complication of spinal anesthesia and an underreported complication of epidural blood patches. Although there are other reported cases of intrathecal blood injection, these cases lack confirmatory imaging and others report injection of mixed blood with other agents.
We present a case report of post-laminectomy cerebrospinal fluid leak who underwent epidural blood patch placement. CT and MRI brain imaging was obtained, depicting intrathecal blood products. The patient had subsequent seizures and respiratory distress, received supportive care, and returned to baseline after several days.
The patient's clinical course illustrates the potential complications of blood products within CSF, including seizures and respiratory distress, which improved with supportive care in this case. Importantly, to our knowledge, this is the only report that clearly depicts injection of purely blood products, without other confounding agents (such as gadolinium), into intrathecal space and with diffuse spread through the CSF as visualized on CT and MRI imaging.
鞘内注射是椎管内麻醉的罕见并发症，也是硬膜外血贴的报告较少的并发症。虽然还有其他报道的鞘内注射血液的病例，但这些病例缺乏确认性的影像学检查，其他病例报告注射的是混合有其他药物的血液。
我们报告了一例脊麻后脑脊液漏患者行硬膜外血贴治疗的病例。进行了 CT 和 MRI 脑成像，显示了鞘内血液产物。患者随后出现癫痫发作和呼吸窘迫，接受了支持性治疗，几天后恢复至基线水平。
该患者的临床病程说明了 CSF 中血液产物的潜在并发症，包括癫痫发作和呼吸窘迫，在这种情况下，支持性治疗可改善这些并发症。重要的是，据我们所知，这是唯一一份明确描述将纯血液产物（无其他混杂剂，如钆）注入鞘内空间，并在 CT 和 MRI 成像上显示通过脑脊液广泛扩散的报告。
