Illinois College of Optometry, Chicago, Illinois.
Optom Vis Sci. 2022 Sep 1;99(9):721-724. doi: 10.1097/OPX.0000000000001916. Epub 2022 Jun 9.
Epidural anesthesia is a safe procedure used in pregnant patients during labor. However, caution should be exercised in those patients who have concurrent Arnold-Chiari malformation.
This study aimed to report a rare and atypical presentation of downbeat nystagmus, in a pregnant patient with Arnold-Chiari malformation type 1 (ACM1), secondary to accidental dural puncture.
A 31-year-old African American woman presented with a chief complaint of decreased vision and oscillopsia that occurred after giving birth, 6 months earlier. Her medical history before presentation was unremarkable. Her delivery was typical; however, the patient did receive epidural anesthesia, which resulted in a dural puncture. The patient noted her symptoms a few days after delivery. Upon examination, persistent downbeat nystagmus was noted in both eyes. Magnetic resonance imaging revealed a 2.5-cm inferior displacement of the cerebellar tonsils below the foramen magnum consistent with ACM1. The patient was referred to neurosurgery for posterior fossa decompression. However, surgery was deferred until appropriate weight reduction could be achieved. Follow-up examination 6 months later revealed no change in her clinical findings.
This case report highlights an atypical presentation of downbeat nystagmus secondary to an accidental dural puncture in a pregnant patient with undiagnosed ACM1. Clinicians should consider the importance of considering ocular complications that can occur in pregnant patients with ACM1. Questioning of women who have recently given birth about epidural anesthesia should be considered with an acute presentation of downbeat nystagmus.
硬膜外麻醉是一种在孕妇分娩过程中使用的安全程序。然而，对于同时患有 Arnold-Chiari 畸形的患者，应谨慎使用。
本研究旨在报告一例罕见且不典型的 1 型 Arnold-Chiari 畸形（ACM1）患者因意外硬膜穿刺引起的下斜性眼球震颤的病例。
一名 31 岁非裔美国妇女主诉视力下降和眼球震颤，这些症状发生在 6 个月前分娩后。她的既往病史无明显异常。她的分娩过程正常；然而，患者确实接受了硬膜外麻醉，导致硬膜穿刺。患者在分娩后几天注意到了这些症状。检查时，发现双眼持续出现下斜性眼球震颤。磁共振成像显示小脑扁桃体下 2.5 厘米的枕骨大孔下方有 2.5 厘米的下移位，符合 ACM1。患者被转介到神经外科进行后颅窝减压。然而，手术被推迟到可以适当减轻体重为止。6 个月后的随访检查显示她的临床发现没有变化。
本病例报告强调了一例在未诊断出 ACM1 的孕妇中因意外硬膜穿刺引起的不典型下斜性眼球震颤的表现。临床医生应考虑到 ACM1 孕妇可能出现的眼部并发症的重要性。对于最近分娩的妇女，如出现下斜性眼球震颤的急性发作，应考虑询问硬膜外麻醉的情况。
