Caruso James P, Aoun Salah G, Kabangu Jean-Luc K, Ogunkua Olutoyosi, Bagley Carlos A
Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA.
Anesthesiology, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2021 Jan 23;13(1):e12871. doi: 10.7759/cureus.12871.
Epidural analgesia is an efficient method of controlling pain and has a wide spectrum of therapeutic and diagnostic applications. Potential complications may occur in a delayed fashion, can remain undiagnosed, and can be a source of significant morbidity. We present a 37-year-old woman presented with severe spontaneous occipital headaches, diplopia, and dizziness that occurred spontaneously six weeks after giving birth. Her primary method of pain control during labor was epidural analgesia. Her neurologic exam revealed a cranial nerve six palsy with ptosis, and her brain MRI demonstrated a Chiari I malformation which had not been previously diagnosed. CT myelography of the lumbar spine revealed extradural contrast extravasation within the interspinous soft tissue at L1-L2, which was the site of her prior epidural procedure. She underwent epidural blood patch administration, and her cranial nerve palsy resolved along with all of her other symptoms. The development of concurrent Chiari I malformation and cranial nerve palsy after epidural anesthesia is an exceptionally rare occurrence. Neurologic complications after epidural anesthesia are likely under-reported, since patients are often lost to follow-up or have subtle neurologic signs which can easily be missed. This frequently delayed presentation emphasizes the importance of patient education and the necessity of a detailed neurological exam when symptoms occur.
硬膜外镇痛是一种有效的疼痛控制方法，具有广泛的治疗和诊断应用。潜在并发症可能延迟出现，可能未被诊断出来，并且可能是严重发病的根源。我们报告一名37岁女性，在产后六周出现严重的自发性枕部头痛、复视和头晕。她分娩期间的主要疼痛控制方法是硬膜外镇痛。她的神经系统检查显示有动眼神经麻痹伴上睑下垂，脑部磁共振成像显示有I型Chiari畸形，此前未被诊断出。腰椎CT脊髓造影显示L1-L2棘突间软组织内硬膜外造影剂外渗，这是她之前硬膜外操作的部位。她接受了硬膜外血贴治疗，动眼神经麻痹以及其他所有症状均得到缓解。硬膜外麻醉后并发I型Chiari畸形和动眼神经麻痹极为罕见。硬膜外麻醉后的神经系统并发症可能报告不足，因为患者常常失访或有轻微的神经系统体征，很容易被漏诊。这种经常延迟出现的情况强调了患者教育的重要性以及出现症状时进行详细神经系统检查的必要性。
