Aracnoidite Adesiva Medular com Complicações Neurológicas Graves pós-Raquiqnestesia

English

Resumo

Arachnoiditis is an inflammation of the arachnoid layer. When the condition is accompanied by accumulation of fibrinous adhesive bands leading to reduced blood supply, tethering and encapsulation/tethering of nerve roots and spinal cord, the term adhesive arachnoiditis (AA) is employed. AA resulting from procedures involving spinal anaesthesia and presenting with severe neurological debilitation is extremely rare but may present in many different forms. Such findings may develop anywhere from minutes to months after the procedures, and response scenarios can vary from spontaneous resolutions to intractable states. We herein present the cases of two patients with severe neurological sequalae after neuraxial anaesthesia and their respective management. Several distinct, probably concomitant and somewhat unpredictable factors may lead to or promote the development of AA after spinal anaesthesia. Nonetheless, even if not completely avoidable, awareness for the condition may allow for an earlier diagnosis and intervention, which may reflect in mitigated neurological sequels. 

Downloads

Dados de downloads ainda não estão disponíveis.

Referências

1 Dahlgren N, Törnebrandt K. Neurological complications after anaesthesia. A follow‐up of 18 000 spinal and epidural anaesthetics performed over three years. Acta Anaesthesiol Scand 1995. doi:10.1111/j.1399-6576.1995.tb04190.x.
2 Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthesias in Finland 1987-1993. A study based on patient insurance claims. Acta Anaesthesiol Scand 1997. doi:10.1111/j.1399-6576.1997.tb04722.x.
3 Ross JS, Masaryk TJ, Modic MT, Delamater R, Bohlman H, Wilbur G et al. MR imaging of lumbar arachnoiditis. AJR Am J Roentgenol 1987. doi:10.2214/ajr.149.5.1025.
4 Eisenberg E, Goldman R, Schlag-Eisenberg D, Grinfeld A. Adhesive arachnoiditis following lumbar epidural steroid injections: A report of two cases and review of the literature. J Pain Res 2019. doi:10.2147/JPR.S192706.
5 Nguyen C, Ho KC, Haughton VM. Effect of lidocaine on the meninges in an experimental animal model. Invest Radiol 1991. doi:10.1097/00004424-199108000-00010.
6 Kotani N, Kushikata T, Hashimoto H, Kimura F, Muraoka M, Yodono M et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med 2000. doi:10.1056/NEJM200011233432102.
7 Campbell JP, Plaat F, Checketts MR, Bogod D, Tighe S, Moriarty A et al. Safety guideline: Skin antisepsis for central neuraxial blockade: Association of Anaesthetists of Great Britain and Ireland Obstetric Anaesthetists’ Association Regional Anaesthesia UK Association of Paediatric Anaesthetists of Great Britain and Ireland. Anaesthesia. 2014. doi:10.1111/anae.12844.
8 Whedon JM, Glassey D. Cerebrospinal fluid stasis and its clinical significance. Altern. Ther. Health Med. 2009.
9 Killeen T, Kamat A, Walsh D, Parker A, Aliashkevich A. Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: A case report and review. Anaesthesia 2012. doi:10.1111/anae.12017.
10 Basaran R, Kaksi M, Efendioglu M, Onoz M, Balkuv E, Kaner T. Spinal arachnoid cyst associated with arachnoiditis following subarachnoid haemorrhage in adult patients: A case report and literature review. Br. J. Neurosurg. 2015. doi:10.3109/02688697.2014.976175.
Publicado
2020-10-02
Como Citar
Bastos, P., Barbosa, R., Reizinho, C., & Alves, L. (2020). Aracnoidite Adesiva Medular com Complicações Neurológicas Graves pós-Raquiqnestesia: English. Revista Da Sociedade Portuguesa De Anestesiologia, 29(3), 174-177. https://doi.org/10.25751/rspa.19899