Focal Neurologic Deficit After Epidural Catheter Removal Leads to Meningioma Diagnosis.

Autor:	Clond MA; Anesthesiology, State University of New York Upstate Medical University, Syracuse, USA., Koleini EA; Anesthesiology, State University of New York Upstate Medical University, Syracuse, USA., Richardson TE; Pathology, University of Texas Health Science Center at San Antonio, San Antonio, USA., Zyck SA; Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA., Sharma V; Anesthesiology and Pain, State University of New York Upstate Medical University, Syracuse, USA., Dhir M; Surgery, State University of New York Upstate Medical University, Syracuse, USA., Li F; Anesthesiology, State University of New York Upstate Medical University, Syracuse, USA., Krishnamurthy S; Neurosurgery, State University of New York Upstate Medical University, Syracuse, USA., Thomas S; Anesthesiology and Pain, State University of New York Upstate Medical University, Syracuse, USA., Zhang X; Anesthesiology, State University of New York Upstate Medical University, Syracuse, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2021 Jun 29; Vol. 13 (6), pp. e16015. Date of Electronic Publication: 2021 Jun 29 (Print Publication: 2021).
DOI:	10.7759/cureus.16015
Abstrakt:	We present an unusual case of a 60-year-old female who developed subtle, new-onset left upper and lower extremity weakness on day five of perioperative thoracic epidural placement. The onset of a focal neurological deficit after epidural placement usually raises suspicion for the presence of an epidural hematoma, abscess, or traumatic cord lesion. However, in this patient, brain imaging revealed a large, previously undiagnosed intracranial mass. Classically, the risk of mass-related intracranial pressure shifts leading to neurological changes is associated with spinal techniques, including diagnostic lumbar puncture, combined spinal-epidural catheter analgesia, and unintended dural puncture during epidural placement. However, based on this case and our summary of case reports in the literature, we determined that symptom onset associated with an intracranial mass may also arise after apparently uncomplicated epidural placement. Symptom onset in our case series ranged from six hours to ten days and was highly variable depending on tumor location, with reported signs and symptoms including headache, vision changes, focal deficits, or alterations of consciousness. Further studies are required to establish definitive causation between the epidural technique and changes in cerebrospinal fluid pressures leading to symptom onset. Though rare, this is a time-sensitive diagnosis that must be considered for any patient with unexplained neurological findings after neuraxial anesthesia. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2021, Clond et al.)
Databáze:	MEDLINE
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