Reactions 1396 - 7 Apr 2012

SBupivacaine

Arachnoiditis with syringomyelia and arachnoidcyst: case report

A 29-year-old woman developed adhesive arachnoiditis(AA), with extensive syringomyelia (ES) and a giant anteriorarachnoid spinal cyst (AASC) following a spinal injection ofbupivacaine.

The woman underwent combined epidural and spinalanaesthesia for a caesarean section, which included aspinal injection of 2.4mL isobaric 0.5% bupivacaine. Herepidural tube was removed 1 day after surgery, and shedeveloped lower extremity listlessness and numbness. Onemonth later, she experienced transient left chest pain at T6.Five months after the caesarean section, she developedanuria, followed by gait disturbance due to spasticity andmotor weakness, numbness below T5, and patellar andankle clonus. She was admitted, and an MRI and CTmyelography revealed an AASC compressing the spinalcord, convergence of the cauda equina, and an adhesivelesion below T7.

The woman underwent adhesiolysis and a laminectomy.One year after surgery, her motor function had improved,and she could walk with a cane; however, her bladderfunction was unchanged, while an MRI revealed ES in thelower thoracic cord and no change in the AASC volume.Three years after surgery, she presented again with gaitdisturbance and lower extremity weakness. An MRIshowed an increase in size of the AASC. She underwentanother laminectomy, and a shunt operation into the AASC.Three years later, she could walk without a cane. An MRIrevealed no improvement in the lumbar AA or ES in thelower thoracic cord, but a reduction in AASC anddecompression at the upper thoracic level.

Author comment: "[I]t is conceivable that theadministration of bupivacaine or minor injury caused by theepidural tube was related to an inflammatory reaction of thepia and dural mater in our case, which might have inducedthe initial onset of numbness and listlessness".Hirai T, et al. Adhesive arachnoiditis with extensive syringomyelia and giantarachnoid cyst after spinal and epidural anesthesia: A case report. Spine 37:E195-E198, No. 3, 1 Feb 2012. Available from: URL: http://dx.doi.org/10.1097/brs.0b013e31822ba817 - Japan 803068864

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Reactions 7 Apr 2012 No. 13960114-9954/10/1396-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved