1/19. spinal cord injury following an attempted thoracic epidural.Unsuccessful attempts were made to insert a thoracic epidural in an anaesthetised patient. Signs of spinal cord damage were observed the following day. magnetic resonance imaging demonstrated a haematoma anterior to the spinal cord. Surgical exploration revealed an intradural haematoma and a needle puncture of the cord. The patient suffered a permanent paraparesis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/19. The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. methods: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/19. Cervical hematomyelia: a rare entity in a neonate with cesarean section and surgical recovery.spinal cord injury with or without trauma has been reported in the perinatal period. The prognosis depends primarily on diagnosis of the level, extent and nature of the lesion, established by correlations between clinical, imaging and electrophysiological data. A 25-day-old boy with normal birth weight delivered at term by cesarean section was transferred to Inonu University Turgut Ozal Medical Center because of respiratory distress and brachial diplegia. A suspicious medullary lesion on cervical computerized tomography was confirmed as an intramedullary lesion extending from C3 to D1 on magnetic resonance imaging (MRI). Emergent surgery consisting of exposure of the lesion site and interlaminar direct puncture of the lesion under fluoroscopy revealed that the pathology was an intramedullary hematoma. The partial evacuation of the lesion with direct puncture, the patient's neurological improvement and close follow-up of the patient with ultrasonography, electrophysiology and MRI are discussed in the light of recent literature.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
4/19. spinal cord injury in a child caused by an accidental dural puncture with a single-shot thoracic epidural needle.IMPLICATIONS: A child experienced a spinal cord injury by an accidental dural puncture during thoracic epidural anesthesia. A magnetic resonance image was used for diagnosis and treatment.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
5/19. Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient.We discuss the etiology of a delayed spinal cord injury after epidural anesthesia without paresthesia. The description of such a case in an awake, adult patient who underwent a Whipple resection is provided. An epidural was performed at approximately the T8-9 interspace with the patient in the sitting position after 1 mg of midazolam was administered. On the first attempt, a dural puncture occurred. The patient did not report any paresthesia or pain. The needle was withdrawn and a second attempt was made one interspace lower. At this level, the epidural catheter was advanced into the epidural space uneventfully. Postoperatively, the patient suffered decreased motor function in the right leg. magnetic resonance imaging revealed high signal intensity within the spinal cord, indicating cord edema compatible with direct needle trauma. An extradural fluid collection consistent with a hematoma was also noted. Although it may be impossible to confirm if the spinal cord injury was a result of direct needle trauma, hematoma, or a combination of needle trauma and hematoma, these events clearly raise the important question of whether an awake patient will always report paresthesia secondary to spinal cord trauma. IMPLICATIONS: This case reminds anesthesiologists that we should not simply assume paresthesia will always occur and be reported if a needle encroaches on the spinal cord even in an awake patient.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/19. Spinal epidural hematoma after removal of an epidural catheter: case report and review of the literature.We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. We studied 40 previous reports from 1952 to 2000, and we also investigated anticoagulant therapy and pathologic states, puncture difficulties and bleeding at the point of insertion, and its onset. In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/19. foot drop after spinal anesthesia in a patient with a low-lying cord.Damage to the spinal cord/conus medullaris due to incorrect identification of the lumbar space is a known complication of lumbar puncture. However, damage to a low-lying cord using an appropriate interspace is extremely rare. We describe a 26-year-old woman who underwent emergency caesarean section under spinal anesthesia. She developed right foot drop immediately after surgery, which gradually recovered over the next 10 months. magnetic resonance imaging revealed a low lying cord with a fatty filum terminale and intramedullary T2 hyperintensity, suggestive of needle damage.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/19. subarachnoid hemorrhage and spinal root injury caused by acupuncture needle--case report.The authors report a case of subarachnoid hemorrhage and spinal root injury caused by an acupuncture needle buried in the posterior neck about 30 years before onset. A 33-year-old female presented with sudden onset of severe occipital headaches. Plain x-ray films of the cervical spine revealed a fine gold needle, about 1.5 cm in length, between the C1 and C2 vertebrae. The needle was piercing the spinal nerve root through the dural vein, and was removed. Postoperatively, the pain exacerbated by neck movement disappeared.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
9/19. Inadvertent cervical cord puncture during myelography via C1-C2 approach.C1-C2 puncture is a procedure commonly performed to assure satisfactory cervical myelography. Cord injury with neurological deficit has been reported following intramedullary injection of myelographic contrast material. We report a case of inadvertent intramedullary injection of metrizamide which was initially discovered during postmyelographic CT scanning. The patient had very minimal symptoms during the procedure and had no immediate or long-term complications.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
10/19. spinal cord injury caused by a lateral C1-2 puncture for cervical myelography.A case is reported of a metrizamide injection into the cervical spinal cord during myelography via a lateral C1-2 puncture. This resulted in a mild persistent neurological deficit. The literature is reviewed.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
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