Reactions 1332 - 18 Dec 2010

SBupivacaine

Conus medullaris lesion following spinaladministration: case report

A 34-year-old woman received 2mL of 0.5% hyperbaricbupivacaine injected into her L2-L3 spinal area forsubarachnoid anaesthesia during a caesarean section.During the procedure, she reported pain during theinsertion of the needle. On the first postoperative day, shedeveloped intense pain and motor impairment of the leftleg. Her condition worsened over the following week. Inaddition to pain, she had disturbed micturition, loss oftendon and plantar reflexes, dysaesthesia, motor deficit anddeficit of all sensory modalities at the L4–S1 level. A MRIscan revealed hyperintense spinal cord lesion, extendingfrom T12 to L1. Her motor deficit partially improved, butpain, sensory and micturition deficits continued. She waslater diagnosed with neuromyelitis optica, thought to beunmasked following discovery of the conus medullarislesion.

Author comment: "A clear cause-effect relationshipbetween subarachnoid anaesthesia and a conus medullarislesion was present"Facco E, et al. Spinal anaesthesia and neuromyelitis optica: cause or coincidence?.European Journal of Anaesthesiology 27: 578-80, No. 6, Jun 2010 -Italy 803046205

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Reactions 18 Dec 2010 No. 13320114-9954/10/1332-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved