Porter J, Lynch L, Hart S, Keohane C
Department of Anaesthesia, Regional Hospital, Wilton, Cork, Ireland.
Can J Anaesth. 1994 Apr;41(4):317-20. doi: 10.1007/BF03009912.
Two cases of neurological dysfunction are presented. Neurological deficits after recovery from anaesthesia are unusual in young women perioperatively. In the first case, a 39-yr-old woman presented at 36-wk gestation with antepartum haemorrhage and in labour. Pregnancy had been complicated by pre-eclampsia and she underwent emergency Caesarean section under general anaesthesia without complication. The trachea was extubated when she was awake but almost immediately she became hypertensive, obtunded and reintubation was required. Her pupils became fixed and dilated but the Computerised Axial Tomogram (CT) was normal. A coagulopathy was evident. She made a full neurological recovery within 24 hr. On the same day, a previously healthy 41-yr-old woman who had undergone uneventful surgery for uterine prolapse 24 hr previously developed headache, nausea and over the next four hours signs of progressive brainstem ischaemia. The CT scan showed oedema of the mid- and hindbrain. Brainstem death was confirmed 12 hr later and the post-mortem revealed acute dissection of the vertebral artery secondary to cystic medial necrosis. Such dramatic neurological sequelae are rare but the importance of identifying "at risk" groups is underlined as is early recognition of neurological injury postoperatively.
本文报告了两例神经功能障碍病例。围手术期麻醉恢复后出现神经功能缺损在年轻女性中并不常见。第一例，一名39岁女性在妊娠36周时因产前出血入院并临产。该孕妇合并先兆子痫，在全身麻醉下接受了急诊剖宫产手术，过程顺利。她清醒后气管插管拔除，但几乎立即出现高血压、意识不清，需要再次插管。她的瞳孔固定且散大，但计算机断层扫描（CT）结果正常。明显存在凝血功能障碍。她在24小时内神经功能完全恢复。同一天，一名此前健康的41岁女性在24小时前接受了子宫脱垂手术，手术过程顺利，术后出现头痛、恶心，在接下来的四个小时内出现进行性脑干缺血的症状。CT扫描显示中脑和后脑水肿。12小时后确诊为脑干死亡，尸检显示继发于囊性中层坏死的椎动脉急性夹层。这种严重的神经后遗症很少见，但强调了识别“高危”人群的重要性以及术后早期识别神经损伤的重要性。
