Cranial Nerve VI Palsy After Dural-Arachnoid Puncture

Hofer, Jennifer; Scavone, Barbara M.

doi:10.1213/ane.0000000000000587

Cited by 30 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other authors believe that incidence may be higher because many patients can be left unattended because of temporary visual disturbance. 59,60 Extraocular muscle palsy usually appears in patients aged 17 to 69 years and at an average age of 42 years. 19 According to our review, the average age was 40.24 ± 13.35 years (within a range of 6-71 years).…”

Section: Resultsmentioning

confidence: 99%

Ocular Motor Palsy After Spinal Puncture

del-Río-Vellosillo

García-Medina

Pinazo-Durán

et al. 2017

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6-71 years). The sixth cranial nerve was the most commonly involved (92.1%), with higher frequency in the right eye. Palsy onset started 7.30 ± 4.09 days after puncture. Duration in reversible cases was 80.10 ± 80.67 days. Paresia was permanent in 13 patients, but only 2 patients required extraocular muscle surgery. Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.

show abstract

Section: Resultsmentioning

confidence: 99%

Ocular Motor Palsy After Spinal Puncture

del-Río-Vellosillo

García-Medina

Pinazo-Durán

et al. 2017

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

“…With the improvement of the standard of regional anaesthesia, the incidence decreased in recent decades. III, IV, V, VI, VII, VIII and X cranial nerve palsy have been described with VI cranial nerve palsy being the commonest [2][3][4][5][6][7]. Lower cranial nerve palsies are extremely rare and case reports are also minimal [8,9].…”

Section: Introductionmentioning

confidence: 99%

A Unique Case of Bilateral Vocal Fold Paralysis Following Spinal Anaesthesia

Mitra

Biswas

Shailendra

et al. 2020

EUREKA: Health Sciences

View full text Add to dashboard Cite

Cranial nerve palsies are potential but rare complications of spinal anaesthesia. Most of the literatures support upper cranial nerve palsies like VI, IV and III cranial nerve palsies. Intrathecal hypotension resulting in tractional injury of the cranial nerves is the likely mechanism of injury. As on date, some cases of unilateral vocal fold paralysis and very little bilateral vocal fold paralysis have been described in case reports. We have described a patient who developed hoarseness and dysphagia 7 days after receiving spinal anaesthesia for fixation of inter-trochanteric fracture femur. The patient was diagnosed with bilateral vocal fold paralysis. He was managed conservatively and exhibited complete spontaneous recovery as has been described in the previously reported cases. Any patient presenting with idiopathic vocal fold paralysis should be enquired about the history of spinal or epidural anaesthesia. If the history is affirmative, then it points towards transient intrathecal hypotension as a potential etiology of the cranial nerve palsy.

show abstract

“…The mechanism of injury is thought to begin with a puncture of the dura and a subsequent leak of cerebrospinal fluid (CSF). Intracranial hypotension can then develop and result in a caudal displacement of the brain and brainstem which places traction on the cranial nerves [7,8]. This traction is thought to cause stretching, compression, or ischemia of the nerve [7].…”

mentioning

confidence: 99%

“…Palsies of the oculomotor, trochlear, trigeminal, abducens and facial nerve have occurred after both spinal and spinal-epidural anesthesia [6][7][8][10][11][12]. The most commonly affected cranial nerve is the abducens (CN VI).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Is Unilateral Vocal Fold Paralysis a Rare Complication of Spinal Anesthesia? A Case Report

Guevara¹

2016

J Anesth Clin Res

View full text Add to dashboard Cite

A 47 year old woman underwent an open reduction and internal fixation of a left ankle fracture under spinal anesthesia. In the recovery room, she noticed a sudden onset of dysphonia. Fiberoptic examination revealed an immobile right vocal fold. Her symptoms gradually improved over the next few weeks with conservative treatment. By the eighth week, her voice had returned to normal. Anesthesiologists should be aware that dysphonia that develops immediately or shortly after spinal anesthesia may represent a unilateral vocal fold paralysis (VFP).Keywords: Vocal fold paralysis; Hoarseness; Dysphonia; Vagus nerve; Cranial neuropathy; Recurrent laryngeal nerve; Abducens nerve; Intracranial hypotension; Spinal anesthesia complications Case ReportA 47 year old woman underwent an open reduction and internal fixation of a left posterior pilon (tibia) and fibula fracture. The patient refused general anesthesia and intubation because she had undergone a partial cricotracheal resection for subglottic stenosis seven years earlier. Her only symptom at that time was dyspnea. She had never been previously intubated; she had not experienced any changes in her vocal quality or strength. The cause of her subglottic stenosis was considered to be idiopathic. Her cricotracheal resection had been performed successfully and she had normal vocal fold function postoperatively. The patient was 58 kg and 173 cm in height. She was ASA Class II, not a diabetic, and a nonsmoker. She had no history of neuritis, neuropathies, inflammatory conditions, recent vaccinations, or any recent upper respiratory infections. Past surgical history included a cesarean section under epidural anesthesia and a breast augmentation under local anesthesia. Medications included vitamins, calcium, fish oil, and magnesium.The patient was consented for a spinal anesthetic with peripheral nerve blocks for postoperative pain management. After intravenous sedation with three milligrams of midazolam, the patient was placed into a sitting position for the spinal anesthetic. A 25 gauge pencil-point needle was used to place the spinal block at the L3-4 interspace. On the first attempt, in an atraumatic fashion, the patient received twelve milligrams of hyperbaric bupivacaine. The patient was returned to a supine position and five milligrams of ephedrine was given when there was an initial decrease in mean arterial pressure from 85 to 70 mmHg. The spinal block produced a surgical level block to T4. An ultrasoundguided saphenous nerve block was performed utilizing 10 mL of 0.25% bupivacaine.The patient was placed into the prone position. All pressure points were well-padded, avoiding hyperextension and hyperflexion of the neck and shoulders. During positioning the patient spoke in a normal manner and stated that she was comfortable. Intravenous sedation consisted of propofol at a rate of 50-75 mcg/kg/minute and a total of three milligrams of midazolam and 500 mcg of fentanyl were administered incrementally.At the completion of the three hour surgery, the patient receive...

show abstract

Cranial Nerve VI Palsy After Dural-Arachnoid Puncture

Cited by 30 publications

References 29 publications

Ocular Motor Palsy After Spinal Puncture

Ocular Motor Palsy After Spinal Puncture

A Unique Case of Bilateral Vocal Fold Paralysis Following Spinal Anaesthesia

Is Unilateral Vocal Fold Paralysis a Rare Complication of Spinal Anesthesia? A Case Report

Contact Info

Product

Resources

About