We report a case of serious neurologic injury due to inadvertent epidural injection of 8 ml of the antiseptic 2% chlorhexidine in 70% alcohol during a procedure aimed to relieve the pain of labour. This resulted in immediate severe back pain, progressive tetraparesis and sphincter dysfunction caused by damage to the spinal cord and nerve roots. Subacute hydrocephalus necessitated drainage, but cranial nerve and cognitive function were spared. Magnetic resonance imaging documented marked abnormality of the spinal cord and surrounding leptomeninges. In the ensuing eight years, there has been clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe.Several cases of arachnoiditis subsequent to neuraxial blockade have been reported 1-7 . Typically, the neurological consequences have been devastating and irreversible. The causative agent has usually been uncertain, but the use of chlorhexidine in alcohol for skin antisepsis has been common to most recent reports 5,7 . The pathogenic role of alcohol itself is unclear.We report a case of severe neurological complications following inadvertent injection of 2% chlorhexidine in 70% alcohol into the epidural space. We compare the clinical course and radiological findings of our patient, in whom the causative agent is beyond doubt, to previously reported cases in which the cause has been speculated. We present clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe. This report is published with written consent from the patient. Case historyA 32-year-old primigravida presented at term in early labour in mid-2010. An epidural for pain relief was performed by the duty anaesthetist. Lightly tinted 2% chlorhexidine in 70% alcohol was decanted into a metal pot on the sterile field. Sterile saline was decanted into a second metal pot, which was placed at the opposite end of the field. Asepsis of the back was performed using a swab soaked in the antiseptic. The epidural needle was placed uneventfully using the loss-of-resistance to saline technique. The procedure was complicated by suspected intravascular placement of the epidural catheter, which was removed. During the repeat procedure, the loss-of-resistance syringe was filled in error with fluid from the pot containing the antiseptic, which was injected into the epidural space. This resulted in immediate, severe back pain. The error was identified, the procedure was abandoned, and the patient and her husband were informed of events. There was no sign of dural puncture. Subsequently, an effective epidural was placed at the level above and a normal vaginal delivery of a healthy child followed.In the absence of evidence to suggest that cerebrospinal fluid (CSF) drainage or lavage may be of benefit, neurosurgical and neurological opinion favoured expectant treatment. Dexamethasone 4 mg sixth-hourly was administered in the hope of limiting chemically-induced inflammation.Initially, it was difficult to assess lower limb strength due to back pain,...
We report a case of Amyloidosis of larynx in a 60-year-old adult who reported to us with hoarseness of voice of 3 years long duration and no other symptoms. Patient was treated successfully with endoscopic curettage of the mass with no inadvertent ill effects.
Foreign body inhalation is commonly seen in children who need to be treated promptly and immediately otherwise it leads to complications. We here report a rare case of foreign body detached part of metallic tracheostomy tube in left main bronchus.
Tuberculosis is one of the biggest health challenge, the world is facing. Cervical lymphadenitis is a common manifestation of mycobacterial infections encountered in otorhinolaryngologic practices. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it minimizes other pathological processes and eyelids in consistent physical and lab findings. A high index of suspicion is needed for the diagnosis of mycobact cervical lymphadenitis and should be considered in the differential diagnosis of a cervical mass especially in endemic areas. Key words: Cervicofacial masses; lymphadenopathy FNAB; HPE; developmental malformations; cystic lesions. DOI: 10.3126/saarctb.v5i2.3074 SAARC J. Tuber. Lung Dis. HIV/AIDS 2008 Vol.5(2) 31-35
Background: Seizures and epilepsy are common neurological disorders which significantly affect the quality of life. About 10 % of the population experiences a seizure in their lifetime, and are a common source of referrals for neurological consultation. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions and vary in frequency, from less than 1 per year to several per day. Owing to scanty information on epidemiology and etiology on seizures in Kashmir, the present study was undertaken to provide update, identify gaps in our present knowledge. Methodology: This was a prospective and observational study undertaken in two phases. In the first phase households in Hazratbal Community Block Srinagar were surveyed for seizure disorder using cluster sampling. Individuals with seizures were clinically evaluated with detailed history and thorough clinical examination as per protocol in the second phase. All patients were subjected to haematological, biochemical and radiological examination. Special investigations like EEG, and CSF analysis were done wherever it was required for patient. Results: The total number of cases included in this study was 47 with male to female ratio of 1:0.88. Majority of the cases were in the age group of 20-39 years followed by 40-59 years. Neuroinfection was the predominant cause of seizures with encephalitis accounting for 12.63%. Other causes included cerebrovascular accidents (25.53%), metabolic (17.02%), miscellaneous (8.51%) and idiopathic (12.76 %).Higher incidence of seizures was observed in the age group of 20-29, followed by 40-49 and 30-39 age groups. Neuroinfection was observed as the leading cause of seizures in the age group of 20-29 years, followed by age group of 40-49 and 30-39 years. In the age group of 50-59 years metabolic was the common cause of seizures followed by CVA and neuroinfection. Cerebrovascular accidents were found important cause for seizures in all age groups with higher incidence in 40-49 age groups. Conclusion: Prevalence is a measure of the disease burden in the community which has to be considered when planning the health needs. Seizure being a medical emergency, determination of its epidemiology and etiology is a necessary step in its prevention and management. In a sample of 15748 taken randomly out of a population of 150,000, 47 cases of seizure were found. Majority of seizures occurred in the age groups of 20-49 years. Etiological spectrum of seizures was varied and included cerebrovascular accidents, neuroinfection, metabolic, tumour, idiopathic. Neuroinfection and CVA account for significant number of seizures in all age groups.
Tuberculosis of larynx is a rare form of tuberculosis. Patients usually present with hoarseness of voice or dysphagia and other non- specifi c constitutional symptoms like fever or localized pain. We are reporting a case of 55 year old male who presented to us with hoarseness of voice, odynophagia and a proliferative growth in the epiglottis which was diagnosed as laryngeal tuberculosis on histopathological examination (HPE). He also had associated pulmonary tuberculosis. DOI: http://dx.doi.org/10.3126/saarctb.v8i1.5891 SAARCTB 2011; 8(1): 41-43
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