Aseptic meningitis following a bupivacaine spinal anesthesia

Abstract

Spinal anesthesia complicated by meningitis is rare. The diagnosis is difficult and the clinical signs are unspecific. There is a subgroup called aseptic meningitis of a different mechanism (hypersensitive reaction and irritation of the meninges), which must be identified for appropriate care. We report the case of aseptic meningitis resulting from bupivacaine use complicating spinal anesthesia. She is 31 years old and was admitted to the intensive care unit for meningitis following a Caesarean delivery. 10 hours after the procedure, she was found to have severe headache, neck stiffness and was found restless. She lost consciousness; she was treated by attending physicians. A CT scan have been performed and was found normal. 24 hours after intubation, the patient woke up. The clinical and biological valuations were normal, allowing for the elimination of the other causes of meningitis.

Post spinal meningitis with subdural collection: an uncommon complication after spinal anaesthesia for caesarean section

“…The treatment of post spinal meningitis does not differ much from the typical treatment for meningitis. It includes early empirical broad-spectrum antibiotics [12] and subsequent de-escalation based on cultures and sensitivity profile. A longer treatment is needed for complicated infection.…”

Chemical meningitis after cervical transforaminal epidural steroid injection: a case report

“…However, it might be caused by allergic or hypersensitivity reactions. 9 Although several reports have described chemical meningitis caused by local anesthetics after spinal anesthesia or intrathecal anesthetics and/or steroid injection, 10 – 13 only three cases of chemical meningitis after epidural injection for pain management have been reported. 6 – 8 In 1987, Gutknecht 6 reported a case of chemical meningitis after interlaminar epidural injection at the L12–1, L4–5, and L5–S1 levels with methylprednisolone for treatment of lower back pain and lumbar radicular pain.…”

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“…Aseptic meningitis remains a diagnosis of exclusion. Several case reports on aseptic meningitis attribute it to potentially several causes, including contamination from detergent used to sterilize the spinal needle, hypersensitivity reaction to spinal medication, direct chemical irritation of the meninges, and systemic immunologic hypersensitivity to drugs such as non-steroidal anti-inflammatories (NSAIDS), intravenous immunoglobulins, and antibiotics [13,14,16].…”