Cerebral Sinus Thrombosis After Spinal Anaesthesia : Predisposing Factors , Operating Difficulties and Diagnostic Problems (original) (raw)
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The authors describe a case of cerebral venous sinus thrombosis following subarachnoid anaesthesia, characterized by operative difficulties and lack of patient collaboration. After anaesthesia, the patient reported a positional headache and on the 5 th day following surgery, he developed a frontal tensive headache with dysphoric and depressive symptoms. On the 9 th day he presented with emesis, hypostenia of the upper left limb and ipsilateral positive Babinsky. The diagnosis was made only on the 10 th day. Genetic analyses showed a homozygous mutation of methylene-tetrahydrofolate-reductase associated to hyperhomocysteinemia (21,7μM). The recurrence of post-dural puncture headaches is very frequent in patients undergoing subarachnoid anesthesia, but special attention is required in the event of headache, as well as associated clinical signs and other risk factors, in order to achieve a precocious diagnosis and allow the physician to start a suitable therapy.
Cerebral venous thrombosis initially considered as a complication of spinal-epidural anaesthesia
The Journal of international medical research
Cerebral venous thrombosis is an unusual condition characterized by headache, nausea, vomiting, focal deficits and epileptic seizures. In this case report we describe a patient who presented with headache and focal motor deficits after an uneventful Caesarean section, performed using combined spinal-epidural anaesthesia. Magnetic resonance imaging was performed because of the pronounced neurological symptoms, and a diagnosis of cerebral venous thrombosis was made. The patient was treated with anticoagulant agents and made a complete recovery. This case emphasizes the importance of considering cerebral venous thrombosis in the differential diagnosis of headache in the post-partum period prior to instituting conventional therapy.
Cerebral sinus thrombosis secondary to epidural anaesthesia
2013
Cerebral venous sinus thrombosis (CVST) is an uncommon, and yet potentially fatal, condition; we present a rare case of CVST as a complication of epidural anaesthesia used for caesarean section, we review different aspects of CVST in terms of epidemiology, aetiology, investigations, and treatment, as well as most acceptable theory explaining the pathogenesis in our case report
ANAESTHESIA, PAIN & INTENSIVE CARE, 2018
Venous sinus thrombosis is a rare entity, usually associated with coagulation disorders, inflammatory diseases, trauma, infection, pregnancy and the postpartum period. The most common symptom is headache and without treatment this condition can be fatal. In our case a patient with preeclampsia was initially treated for post-dural puncture headache after spinal anesthesia for cesarean section. After the headache worsened a cerebral venous sinus thrombosis (CVST) was diagnosed. There are several causes of postpartum headache and venous sinus thrombosis is not among the most frequent. Diagnosis can be challenging especially if neuraxial anesthesia was used or in cases of preeclampsia, two of the leading causes of headache in the postpartum period. This report emphasizes the importance of a careful differential diagnosis of headache in the postpartum during the treatment of persistent post-dural puncture headache. Key words: Postpartum headache; Post-dural puncture headache; Neuraxial anesthesia; Differential diagnosis; Cerebral venous sinus thrombosis. Citation: Faísco A, Inácio R, Alexandre G, Ribeiro J, Rodrigues A. Cerebral venous sinus thrombosis after regional anesthesia in a patient with severe preeclampsia - a diagnostic challenge. Anaesth Pain & Intensive Care 2018;22(3):380-382
A Rare Complication of Spinal Anesthesia: Intracranial Subdural Hemorrhage
Archives of Clinical and Experimental Surgery (ACES), 2015
Spinal (subarachnoid) anesthesia (SA) is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs) represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur.
Journal of Neurology Research, 2014
Cerebral venous thrombosis (SVT) was defined for the first time in 1875. It is a rare entity that can occur with different clinics. Superior sagittal sinus is affected most (70-80%), then transverse, sigmoid, and in a lesser extent, cavernous sinus involvement is seen. Cortical and cerebellar veins may also be involved. A 22-year-old male patient presented to the emergency room with mental confusion and seizures. According to the information received from his relatives, he was actively involved in sports for 2 years. That he was using amino acid weighted and high-energy multi-vitamin complexes within a day, and monthly having an injection called Deca-Durabolin: (nandrolone decanoate), is learned. One week before his coming to the hospital, that he had cruciate ligament surgery on his left knee and that spinal anesthesia was administered to him during the operation is determined. Thereafter, it is learnt that he had generalized tonic-clonic seizure and impairment of consciousness was added when he came to the hospital. During the patient's neurologic examination in the emergency service, it is observed that his consciousness tended to fall asleep, and existing of bilateral papilledema and spontaneous movements in the right, and bilateral Babinski was positive. In brain computed tomography and magnetic resonance imaging (MRI) of the patient, in the left temporo-parieto-occipital hemorrhagic infarct and in venous MR angiography, in left transfer sinus, sigmoid sinus and jugular sinus complete thrombus, in right transfer and lateral sinus, reduction in blood stream and a view matched with thrombus were detected. On the 16th day of his hospitalization, brain death was determined in patient. At the arrival of the patient to the clinic, mental confusion, being male, to be accompanied by intracranial hemorrhage shows that poor prognosis.
Post Caesarean Sagittal Sinus Thrombosis after Spinal Anaesthesia:A Case Report
2010
Central venous thrombosis, although rare, is a recognized cause of puerper present a case of successfully managed sagittal sinus thrombosis (SST) developed in a after Caesarean delivery under spinal an Cerebral venous sinus thrombosis is a rare disorder with an incidence of 3:1,000,000, and pregnancy, being a recognized hypercoagulable state, is known to increase the risk of CVST. incidence of CVST, as a complication trimester of pregnancy and the immediate postpartum The association of CVST with pregnancy and puerperium remains a recognized cause of maternal mortality and morbidity in developing countries puerperium stroke 4,5. We report a case of sagittal sinus thrombosis occurring after spinal anaesthesia for caesarean section. Case Report: A previously healthy 23 yr old, ASA I, gravida 1, para 1 parturient was admit hospital at 37 weeks gestation for gestational hypertension associated with uterine contractions. Her past medical history was not significant. Before pregnancy she was taking no medication oral contraceptives. During pregnancy the pa an episode of threatened preterm labour at 32 weeks gestation. Initial physical examination revealed cervical effacement. Her blood pressure was 140/90 mmHg and urinalysis showed 2+ proteinuria. The patient was diagnos within normal limits.
Erythrocyte counts in the cerebrospinal fluid associated with continuous spinal anaesthesia
Acta Anaesthesiologica Scandinavica, 1995
Continuous spinal anaesthesia technique can be associated with peridural haemorrhage due to blood vessel damage caused by the needle or the catheter. We studied whether thrombosis prophylaxis or anticoaguladon medications increase the risk of subarachnoid haemorrhage when continuous spinal anaesthesia is used. Twenty arthroplasty patients received low-molecular-weight heparin preoperatively and twenty-two vascular surgery patients received heparin (100 IU kg-1) peroperatively; eight of the latter patients were on regular preoperative antiplatelet medication. Twenty-four prostate surgery patients, not exposed to heparin or other drugs affecting coagulation, served as controls. A 22-gauge spinal catheter was used and bupivacaine was injected through the catheter. Within the following 24 hours, 4—5 cerebrospinal fluid samples were collected for erythrocyte counts. In the arthroplasty and the vascular group there were five patients each and in the control group seven patients with more than 100 × 106 1-1 erythrocytes in at least one of the samples. The highest erythrocyte count was 23900 × 106 1-1 in a control patient, The 24-hour sample was blood-tinged (erythrocytes >1000X106 1-1) in two patients in the arthroplasty group, in one patient in the vascular group and in four patients in the control group. In spite of the haemorrhages detected in this study, no related neurological symptoms or other serious consequences were observed. The risk of subarachnoid haemorrhage was not increased by drugs affecting coagulation.