Reactions 1127 - 11 Nov 2006

SBupivacaine/sufentanil

Cerebral thrombosis following spinal analgesia?:case report

A 21-year-old woman developed cerebral thrombosis afterspinal analgesia with bupivacaine and sufentanil during labour.

The woman presented at 37 weeks’ gestation with rapidprogression of labour. Spinal analgesia was successfullyperformed at the L3–L4 interspace with 0.5mL of 0.5%bupivacaine and sufentanil 2.5µg. A healthy neonate wasdelivered 30 minutes later. On postpartum day 3, the womandeveloped a dull throbbing frontal headache with neck pain.The headache became worse by postpartum day 5 and wasassociated with dizziness and slight photophobia.

The woman was treated with oral analgesics, caffeine,hydration and rest and her headache improved over the next48 hours. However, on day 8 her headache recurred. She alsodeveloped paraesthesia from the left hand to the face, acuteleft hemiplegia, blurred vision and somnolence. Fundoscopyrevealed mild bilateral papilloedema. Cranial CT and MRIscans showed thrombosis in the posterior sagittal venoussinus with secondary cortical venous infarctions into the leftfrontal and right posterior parietal areas. IV heparin therapywas started. She also developed seizures which were treatedsuccessfully with valproic acid and carbamazepine. Her othermedications included methylprednisolone, paracetamol[acetaminophen] and ranitidine. Further investigationsrevealed that her protein S level was only 48% of normal. Herheadache gradually resolved and she had full motor recoveryby day 14. She was discharged after 24 days with noneurological deficits and advised to continue antiepilepticdrugs and oral anticoagulants until her follow-up 3 monthslater.

Author comment: "[A] cause-effect association is difficultto demonstrate in rare events such as CVT [cerebral veinthrombosis] concomitant with spinal anesthesia, and thequestion is still under debate."Kapessidou Y, et al. Case report: cerebral vein thrombosis after subarachnoidanalgesia for labour. Canadian Journal of Anesthesia 53: 1015-1019, No. 10, Oct2006 - Belgium 801045261

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Reactions 11 Nov 2006 No. 11270114-9954/10/1127-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved