Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess: A case report

Primer Autor
Uribe, Alberto
Co-autores
Merino-Urrutia, Waldo#Villagran-Schmidt, Milca#Ulloa-Vasquez, Priscilla#Carrasco-Moyano, Ruben#Stoicea, Nicoleta#Bergese, Sergio D.
Título
Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess: A case report
Editorial
LIPPINCOTT WILLIAMS & WILKINS
Revista
MEDICINE
Lenguaje
en
Resumen
Rationale:Neuraxial anesthesia is a commonly used type of regional anesthesia. Cauda equina syndrome is an unusual and severe complication of neuraxial anesthesia, and is caused by damage to the sacral roots of the neural canal. We present a case of cauda equina syndrome following spinal anesthesia in a patient who underwent Bartholin abscess drainage.Patient concerns:A 23-year old female scheduled to undergo surgical drainage of Bartholin abscess. Spinal anesthesia was performed with bupivacaine and fentanyl. There were no perioperative adverse events reported. On postoperative day 1, the patient went to the emergency department describing bilateral weakness and pain of the lower extremities (LE).Diagnoses:Lumbar magnetic resonance imaging showed increased gadolinium accumulation in the neural sheath at the level of the cauda equina tracts, consistent with the diagnosis of arachnoiditis and the diagnosis of cauda equina was established.Interventions:The patient received the following emergent treatment: 75mg pregabalin (oral) every 12hours, 20mg (8 drops) tramadol (oral) every 8hours, and 4mg dexamethasone (intravenous) every 6hours. On postoperative day 4, the patient still experienced bilateral flaccid paraparesis (accentuated in the left side), neuropathic pain in low extremities, and left brachial monoparesis. Hence, dexamethasone was instantly replaced with 1g methylprednisolone (intravenous) for 5 days.Outcomes:After completing 5 days of methylprednisolone, on postoperative day 9, the patient experienced less pain in left extremities, osteotendinous reflexes were slightly diminished, and she was able to walk with difficulty for 3 to 5minutes. Greater mobility was evidenced, with right proximal and distal low extremities Medical Research Council Scale grades of 2 and 3 and left proximal and distal low extremities Medical Research Council Scale grades 1 and 2, respectively. Oral prednisone was restarted. Consequently, she was discharged home in stable conditions on postoperative day 25 with a prescription for sertraline, clonazepam, pregabalin, paracetamol, and prednisone.Lesson:The early detection and treatment of complications after neuraxial anesthesia is essential to minimize the risk of permanent damage.
Tipo de Recurso
Artículo original
doi
10.1097/MD.0000000000010693
Formato Recurso
pdf
Palabras Claves
cauda equina syndrome# neurotoxic# spinal anesthesia
cauda equina syndrome# neurotoxic# spinal anesthesia
Ubicación del archivo
http://dx.doi.org/10.1097/MD.0000000000010693
Categoría OCDE
Medicine, General & Internal
Materias
síndrome de cola de caballo# neurotóxico# anestesia espinal
síndrome de cola de caballo# neurotóxico# anestesia espinal
Id de Web of Science
WOS:000434306000038
Título de la cita (Recomendado-único)
Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess: A case report
Identificador del recurso (Mandatado-único)
Artículo original
Versión del recurso (Recomendado-único)
version publicada
Editorial
LIPPINCOTT WILLIAMS & WILKINS
Revista/Libro
MEDICINE
Categoría WOS
Medicina general e interna
ISSN
0025-7974
Idioma
en
Formato
pdf
Tipo de ruta
hibrida
Access Rights
acceso abierto
Derechos de acceso
acceso abierto
Página de inicio (Recomendado-único)
727
Página final (Recomendado-único)
737
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