Gemma M, Bricchi M, Grisoli M, Visintini S, Pareyson D, Sghirlanzoni A
Department of Neuroanesthesia and Intensive Care, National Neurological Institute of Milan C. Besta, Italy.
Acta Anaesthesiol Scand. 1994 Oct;38(7):742-3. doi: 10.1111/j.1399-6576.1994.tb03988.x.
We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space-occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post-epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms. Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.
我们描述了3例患者，他们在单次硬膜外麻醉后出现了神经症状。病例1中，未被识别的脊髓动静脉瘘（AVF）在硬膜外阻滞术后导致双下肢轻瘫。引流AVF的扩张静脉是占位性结构，麻醉溶液的注射可能由于静脉压升高而引发了脊髓潜在的缺血性缺氧。病例2中，硬膜外阻滞后出现了术后持续性鞍区疼痛和感觉减退。在伴有多个椎间盘突出和椎间孔狭窄的狭窄椎管内注射麻醉剂可能急性产生了脊髓或神经根的机械性压迫。病例3表现为硬膜外阻滞后的脊髓蛛网膜炎。尽管该综合征的少数报道病例显示出严重的神经损伤，但我们的患者症状轻微。我们的病例指出了准确的神经病史以及对硬膜外麻醉候选者进行检查的重要性，以及对神经科患者准确了解麻醉史的重要性。
