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Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1103–1106 | Cite as

Dural puncture and iatrogenic pneumocephalus with subsequent transverse myelitis in a parturient

  • D. N. Lucas
  • Angus Kennedy
  • Daryl P. Dob
Clinical Reports

Abstract

Purpose: To report a case of transverse myelitis following inadvertent dural puncture and iatrogenic pneumocephalus and any possible causal relationship is explored.

Clinical features: A 32-yr-old primigravida developed a severe headache associated with pneumocephalus following accidental dural puncture when the loss of resistance to air technique was used to locate the epidural space. She was treated with oxygen 100% to promote resorption of the air and the headache resolved. One month later she developed a sensory disturbance in her feet. Neurological examination revealed reduced sensation to cold and pain to ankle level and bilateral suppressed knee and ankle reflexes but was otherwise normal. A spinal cord lesion (epidural abscess/hematoma) was excluded with an emergency T1 and T2 weighted magnetic resonance imaging (MRI) scan of the lumbar spine. Over the next 48 hr the sensory disturbance worsened to involve her legs and waist. Examination revealed a sensory loss to waist level, reduced joint position sense and vibration sense in her lower limbs and absent knee and ankle reflexes bilaterally, but normal power in both her legs. A further full length T2 weighted MRI scan of the spine showed a small area of high signal at the level of T3 compatible with transverse myelitis. This was treated with high dose corticosteroids and her symptoms resolved over the next three months.

Conclusion: The etiology of transverse myelitis after dural puncture in a parturient could not be identified nor could any causal link be established between the dural puncture, pneumocephalus, and subsequent transverse myelitis.

Keywords

Epidural Space Myelitis Spinal Cord Lesion Dural Puncture Transverse Myelitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Rapporter un cas de myélite transverse consécutive à une ponction involontaire de la dure-mère et à une pneumo-encéphalie, et explorer toute relation causale possible.

Éléments cliniques: Une primigeste de 32 ans a souffert de céphalées intenses associées à une pneumoencéphalie causée par l’effraction accidentelle de la dure-mère lors de l’utilisation de la technique de perte de résistance pour localiser l’espace épidural. Le traitement avec de l’oxygène à 100 % a favorisé la résorption de l’air et éliminé les céphalées. Un mois plus tard, la patiente a ressenti des troubles sensitifs à un pied. L’examen neurologique a révélé une perte de sensation au froid et à la douleur au niveau de la cheville ainsi que la suppression bilatérale des réflexes achilléen et rotulien. Une lésion de la moelle épinière (abcès épidural/hématome) a été exclue à la suite d’un examen pondéré en T1 et T2 de la colonne lombaire, en imagerie par résonance magnétique (IRM) réalisé d’urgence. Pendant les 48 h qui ont suivi, le déficit sensitif s’est aggravé et a touché les jambes et la taille. On notait une perte sensorielle jusqu’à la taille, une diminution du sens arthrocinétique et de la pallesthésie aux membres inférieurs de même que l’absence bilatérale des réflexes achilléen et rotulien, mais une force normale aux deux jambes. Un examen supplémentaire d’IRM de la colonne, pondéré selon le paramètre tissulaire T2 complet, a montré une petite zone de signal important au niveau de T3, ce qui est compatible avec une myélite transverse. Le traitement avec de fortes doses de corticoïdes a éliminé les symptômes au cours des trois mois suivants.

Conclusion: On n’a pu identifier la cause d’une myélite transverse survenue après une ponction de la duremère chez une parturiente, ni un quelconque lien causal entre la ponction de la dure-mère, la pneumoencéphalie et la myélite transverse subséquente.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  1. 1.From the Magill Department of Anaesthesia, Intensive Care & Pain Management and the Department of NeurologyChelsea & Westminster HospitalLondonUK

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