Postoperative Transtentorial Herniation of Occult Meningioma after Uneventful Epidural Anesthesia

Brzeziński, Marek; Paisansathan, Chananait; Bonasera, Lara; Klock, P. Allan

doi:10.4172/2155-6148.1000105

Cited by 3 publications

(5 citation statements)

References 12 publications

(17 reference statements)

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“…This case report describes a rare incidental diagnosis after epidural analgesia. Compared with other reports summarized in Table 1, this is the first to describe this complication after thoracic epidural catheter placement and the first to report focal weakness as the presenting sign [7][8][9][10][11]. The previous case reports consist of four females and one male, ages 49 to 86, presenting for intra-abdominal or orthopedic procedures.…”

Section: Discussionmentioning

confidence: 89%

“…Infectious and traumatic complications are comparatively less common but are prevalent enough to be reported in cross-sectional studies [1][2][3]. Intracranial processes such as stroke after cervical epidural [5] or after spinal anesthesia [6] or brain masses associated with neurological deficits after epidural or spinal anesthesia procedures [7][8][9][10][11] are rare and only reported as case reports.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Focal Neurologic Deficit After Epidural Catheter Removal Leads to Meningioma Diagnosis

Clond¹,

Koleini²,

Richardson³

et al. 2021

Cureus

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We present an unusual case of a 60-year-old female who developed subtle, new-onset left upper and lower extremity weakness on day five of perioperative thoracic epidural placement. The onset of a focal neurological deficit after epidural placement usually raises suspicion for the presence of an epidural hematoma, abscess, or traumatic cord lesion. However, in this patient, brain imaging revealed a large, previously undiagnosed intracranial mass. Classically, the risk of mass-related intracranial pressure shifts leading to neurological changes is associated with spinal techniques, including diagnostic lumbar puncture, combined spinal-epidural catheter analgesia, and unintended dural puncture during epidural placement. However, based on this case and our summary of case reports in the literature, we determined that symptom onset associated with an intracranial mass may also arise after apparently uncomplicated epidural placement. Symptom onset in our case series ranged from six hours to ten days and was highly variable depending on tumor location, with reported signs and symptoms including headache, vision changes, focal deficits, or alterations of consciousness. Further studies are required to establish definitive causation between the epidural technique and changes in cerebrospinal fluid pressures leading to symptom onset. Though rare, this is a time-sensitive diagnosis that must be considered for any patient with unexplained neurological findings after neuraxial anesthesia.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Focal Neurologic Deficit After Epidural Catheter Removal Leads to Meningioma Diagnosis

Clond¹,

Koleini²,

Richardson³

et al. 2021

Cureus

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show abstract

“…Although a CSF volume loss can lead to neurological deterioration even in patients without a brain mass. 19 Post operative accidental finding of right cerebello pontine angle tumour suggestive of epidermoid cyst in MRI may or may not have relation with intra operative complication as patient had no neurological symptoms and signs of raised intracranial tension and tumour itself in pre operative check up as well as patient recovered completely.…”

Section: Discussionmentioning

confidence: 92%

Successful resuscitation despite prolonged cardiac arrest in a patient with undiagnosed intracranial lesion: a case report

2016

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<p class="abstract"><span lang="EN-US">Perioperative cardiac arrests represent the most serious complication of anesthesia and surgery. It is believed that the incidence and mortality of cardiac arrest has declined because of advanced and increased surgical acuity and patients with extremes of age. We described a case of 31 year old male who had deterioration of cardiorespiratory and hemodynamic status in half an hour period after giving spinal anesthesia for hydrocoele operation. After half an hour of giving spinal anesthesia, patient developed supraventricular tachycardia followed by ventricular tachycardia progressed to cardiorespiratory arrest in a fraction of 2 to 3 minutes. He was unconscious and convulsing. Fortunately, this patient was successfully resuscitated with timely and appropriate measures in form of endotracheal intubation, cardiac defibrillation, antiarrythmic and inotropic cardiac medications and anticonvulsant drugs. Patient was shifted to ICU with ionotropic support and anticonvulsant infusion. Patient had apparently no previous cardiorespiratory or neurological complaints. Post-operative MRI report showed right cerebello-pontine angle cistern lesion suggestive of epidermoid cyst.</span></p>

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“…The possibility of brain metastases was also considered but the incidence is extremely rare for gastrointestinal stromal tumors. complication after a thoracic epidural catheter placement, and the first to report focal weakness as the presenting sign [7][8][9][10][11]. The previous case reports consist of four females and one male, ages 49 to 86, presenting…”

Section: Case Descriptionmentioning

confidence: 99%

“…Infectious and traumatic complications are comparatively less common but are prevalent enough to be reported in cross sectional studies [1][2][3]. Intracranial processes such as stroke after cervical epidural [5] or after spinal anesthesia [6] or brain masses causing neurological deficits after epidural or spinal anesthesia procedures [7][8][9][10][11] are rare, and only reported on a case report basis.…”

Section: Introductionmentioning

confidence: 99%

Neurologic Deficits after Epidural Catheter Removal Lead to Meningioma Diagnosis

A¹,

A²,

E³

et al. 2021

Neurosurg Cases Rev

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Postoperative Transtentorial Herniation of Occult Meningioma after Uneventful Epidural Anesthesia

Cited by 3 publications

References 12 publications

Focal Neurologic Deficit After Epidural Catheter Removal Leads to Meningioma Diagnosis

Focal Neurologic Deficit After Epidural Catheter Removal Leads to Meningioma Diagnosis

Successful resuscitation despite prolonged cardiac arrest in a patient with undiagnosed intracranial lesion: a case report

Neurologic Deficits after Epidural Catheter Removal Lead to Meningioma Diagnosis

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