硬膜外麻醉后出现神经功能障碍的原因竟然是？

本文由“小麻哥的日常”授权转载

硬膜外麻醉拔出硬膜外导管后出现神经功能障碍，是不是第一下就想到是麻醉的原因？穿刺、置管及拔管过程中对神经的损伤、局部血肿对神经压破、感染、局麻药对神经的影响等都可能影响神经功能。但也可能是其他原因，如手术因素，甚至患者自身因素，比如说这篇病例报道，就发现了一个很罕见的原因，它是什么呢？一起看看咯！

摘要译文

硬膜外导管拔出后局灶性神经功能障碍一例

我们报告一例罕见的60岁女性患者，在胸段硬膜外阻滞麻醉手术后第五天出现轻微的新发左上肢和下肢无力。

硬膜外麻醉后出现局灶性神经功能障碍通常会引起对硬膜外血肿、脓肿或外伤性脊髓损伤的怀疑。

然而，在这名患者中，颅脑MRI显示了一个以前未诊断的巨大颅内肿块。

通常，与肿块相关的颅内压变化导致神经系统改变的风险与脊柱手术操作有关，包括诊断性腰椎穿刺、腰硬联合导管镇痛和硬膜外导管放置期间的意外硬膜穿刺。

然而，根据这个病例和我们对文献中病例报告的总结，我们确定与颅内肿块相关的症状也可能在明显不复杂的硬膜外置管后出现。

在我们的病例报告中，症状的出现时间从6小时到10天不等，并且根据肿瘤位置的不同而变化很大，报告的症状和体征包括头痛、视力改变、局部神经功能障碍或意识改变。

需要进一步的研究来确定硬膜外技术和导致症状发作的脑脊液压力变化之间的确切原因。

虽然罕见，但对于任何在神经轴麻醉后出现不明原因神经系统症状的患者来说，这是一种时间敏感的诊断。

关键词：

中枢神经系统疾病；

颅内压升高；

硬膜外镇痛；

局灶性神经功能障碍；

脑膜瘤；

神经轴阻滞；

术后问题。

英文日积月累

unusual case奇案，罕见病例

epidural hematoma硬膜外血肿

intracranial pressure颅内压

associated with与…有关; 参加; 与…相联系

lumbar puncture腰椎穿刺

based on以……为基础；在……基础上

原文摘要

Focal Neurologic Deficit After Epidural CatheterRemoval Leads to Meningioma Diagnosis

We present an unusual case of a 60-year-oldfemale who developed subtle, new-onset left upper and lower extremity weaknesson day five of perioperative thoracic epidural placement. The onset of a focalneurological deficit after epidural placement usually raises suspicion for thepresence of an epidural hematoma, abscess, or traumatic cord lesion. However,in this patient, brain imaging revealed a large, previously undiagnosedintracranial mass. Classically, the risk of mass-related intracranial pressureshifts leading to neurological changes is associated with spinal techniques,including diagnostic lumbar puncture, combined spinal-epidural catheteranalgesia, and unintended dural puncture during epidural placement. However,based on this case and our summary of case reports in the literature, wedetermined that symptom onset associated with an intracranial mass may alsoarise after apparently uncomplicated epidural placement. Symptom onset in ourcase series ranged from six hours to ten days and was highly variable dependingon tumor location, with reported signs and symptoms including headache, visionchanges, focal deficits, or alterations of consciousness. Further studies arerequired to establish definitive causation between the epidural technique andchanges in cerebrospinal fluid pressures leading to symptom onset. Though rare,this is a time-sensitive diagnosis that must be considered for any patient withunexplained neurological findings after neuraxial anesthesia.

Keywords: central nervous system disorders;elevated intracranial pressure; epidural analgesia; focal neurologic deficits;meningioma; neuraxial block; postoperative problems.

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