Objective： Cerebrospinal fluid （CSF） rhinorrhea may be a serious complication after neurosurgery. Some of them can be treated conservatively by continuous CSF drainage with a lumbar subarachnoid catheter. On the ot...Objective： Cerebrospinal fluid （CSF） rhinorrhea may be a serious complication after neurosurgery. Some of them can be treated conservatively by continuous CSF drainage with a lumbar subarachnoid catheter. On the other hand, spinal puncture may result in headache by CSF leakage. Methods： Present a 17-year-old female who suffered from CSF rhinorrhea after pituitary surgery was treated by making use of spinal puncture after failed catheter drainage. Results： The patient was successfully treated by this way. Conclusion： Spinal puncture by 16-gauge Touhy needle seems to be a possible way to substitute the traditional continuous lumbar subarachnoid catheter to drain the CSF in patients with rhinorrhea.展开更多
The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with und...The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.展开更多
BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle...BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.RESULTS: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.CONCLUSION: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.展开更多
<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs ...<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs by isolated headache, following post spinal puncture headache (PSPH). We report a case of cerebral venous thrombosis complicating PSPH, following <span>a spinal</span> anesthesia. <b><span>Observation:</span></b><span> A 23-year-old man was admitted to the emergency room for</span> PSPH appeared 6 hours after a spinal <span>aesthesia</span> for removal of osteosynthesis equipment from the<span style="font-family:Verdana;"></span><span style="font-family:;" "=""> right tibial plateau. The headache was <span>fronto</span>-occipital, relieved by lying down. Six days later, <span>headache</span> became permanent, not relieved by morphine, associated with vomiting. The neurological examination was normal. Brain magnetic resonance Magnetic venography showed superior sagittal sinus and right transverse sinus thrombosis. After administration of low molecular weight heparin at curative dose, and warfarin under INR control, the evolution was marked by a rapid regression of headaches on the same day. After a 1-year <span>setback,</span> the patient was asymptomatic. <b>Conclusion:</b> CVT is a rare complication of spinal anesthesia and potentially severe if diagnosed lately. Urgent brain imaging must be performed for any atypical headache or the onset of neurological disorders so as not to misunderstand cerebral vein thrombosis. Controlling the spine anesthesia would reduce the inadvertent perforation of the dura-mother that would lead to CVT complicating post spinal puncture headaches.</span>展开更多
Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be fa...Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.展开更多
文摘Objective： Cerebrospinal fluid （CSF） rhinorrhea may be a serious complication after neurosurgery. Some of them can be treated conservatively by continuous CSF drainage with a lumbar subarachnoid catheter. On the other hand, spinal puncture may result in headache by CSF leakage. Methods： Present a 17-year-old female who suffered from CSF rhinorrhea after pituitary surgery was treated by making use of spinal puncture after failed catheter drainage. Results： The patient was successfully treated by this way. Conclusion： Spinal puncture by 16-gauge Touhy needle seems to be a possible way to substitute the traditional continuous lumbar subarachnoid catheter to drain the CSF in patients with rhinorrhea.
文摘The most common spinal pathology seen in the obstetric population is lumbar disc herniation. There is currently no literature documenting the safety of performing an epidural blood patch on obstetric patients with underlying spinal pathology. We present a case of a patient with known severe lumbar spinal stenosis with compressive radiculopathy who received a successful epidural blood patch without worsening her underlying neurologic symptoms. Epidural blood patches can be safely performed in this patient population. However, the anesthesiologist should be aware of the risk of potentially worsening preexisting neurological deficits. Thus, we advise caution prior to placing an epidural blood patch on these patients. The risks and benefits of the procedure should be carefully weighed and considered. It is important to have a thorough discussion with the patient regarding the risks of an epidural blood patch prior to performing the procedure.
文摘BACKGROUND: The objective of this study is to determine if point-of-care ultrasound(POCUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POCUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care unit.RESULTS: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POCUS when compared to the traditional method of palpation.CONCLUSION: Consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POCUS to identify pre-procedure landmarks when performing an LP.
文摘<b><span style="font-family:Verdana;">Introduction: </span></b>Cerebral venous thrombosis (CVT) is a rare complication of spinal anesthesia. The diagnosis is difficult when it occurs by isolated headache, following post spinal puncture headache (PSPH). We report a case of cerebral venous thrombosis complicating PSPH, following <span>a spinal</span> anesthesia. <b><span>Observation:</span></b><span> A 23-year-old man was admitted to the emergency room for</span> PSPH appeared 6 hours after a spinal <span>aesthesia</span> for removal of osteosynthesis equipment from the<span style="font-family:Verdana;"></span><span style="font-family:;" "=""> right tibial plateau. The headache was <span>fronto</span>-occipital, relieved by lying down. Six days later, <span>headache</span> became permanent, not relieved by morphine, associated with vomiting. The neurological examination was normal. Brain magnetic resonance Magnetic venography showed superior sagittal sinus and right transverse sinus thrombosis. After administration of low molecular weight heparin at curative dose, and warfarin under INR control, the evolution was marked by a rapid regression of headaches on the same day. After a 1-year <span>setback,</span> the patient was asymptomatic. <b>Conclusion:</b> CVT is a rare complication of spinal anesthesia and potentially severe if diagnosed lately. Urgent brain imaging must be performed for any atypical headache or the onset of neurological disorders so as not to misunderstand cerebral vein thrombosis. Controlling the spine anesthesia would reduce the inadvertent perforation of the dura-mother that would lead to CVT complicating post spinal puncture headaches.</span>
文摘Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.
