Sudden unconsciousness during a lesser occipital nerve block in a patient with the occipital bone defect

Okuda, Yasuhisa; Matsumoto, Tsutomu; Shinohara, Miki; Kitajima, Toshimitsu; Kim, P.

doi:10.1046/j.1365-2346.2001.01018.x

Cited by 31 publications

(18 citation statements)

References 15 publications

(12 reference statements)

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“…Also notable is that our patient’s prior craniectomy resulted in a skull defect, although it was minimal after repair. In the literature, there are reports of serious adverse effects after peripheral nerve blocks applied around skull defects . In this case we performed a PNB far from the skull defect without complications.…”

Section: Discussionmentioning

confidence: 92%

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

2020

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Background Peripheral nerve blocks (PNBs) are used for a wide spectrum of headache and facial pain disorders. The objective of this case report is to highlight the erector spinae plane (ESP) block, which has recently been reported to successfully treat headache. Case Presentation A 70‐year‐old man with a history of mild to moderate headaches, previously ruptured aneurysm, and right pterional craniotomy and clipping of an anterior communicating artery aneurysm presented with exacerbation of chronic post‐surgical scalp pain and severe headache with nausea. Results of the physical examination were not consistent with cellulitis of the scalp, complete blood count and chemistry panel results were unremarkable, and imaging revealed an intact aneurysm clip. Given the severe unilateral throbbing pain with associated nausea, he was treated with a variety of migraine abortives and other pain medications without significant relief. ESP block was performed. He tolerated the procedure well without complications. His pain decreased to 2/10 from a baseline of 9 to 10/10 30 minutes after the procedure, and he was pain free the next day. Follow‐up revealed a return of his pain 1 to 2 weeks after the procedure, which prompted follow‐up with an outpatient pain management specialist. Conclusion PNBs, ESP block in our case, can be a useful modality in managing chronic neuralgiform pain for treatment‐refractory patients. It can provide improvement in quality of life and spare the patient from medication side effects. In an inpatient setting, it can decrease length of stay that would otherwise be extended due to a trial of multiple medications until the pain was controlled. PNBs are used for a wide spectrum of headache and facial pain disorders. This case report highlights successful management of chronic neuralgiform pain with the ESP block, which has recently been reported to successfully treat headache. ESP block provided relief to the patient's neuralgiform pain that was refractory to multiple medications, resulting in decreased length of stay, fewer medication side effects, and improved quality of life. It also provided a window for initiation of long‐term pain medications.

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Section: Discussionmentioning

confidence: 92%

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

2020

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“…Infection or bleeding may result from any percutaneous technique, though these are usually minor problems. A case of sudden unconsciousness due to inadvertent subarachnoid injection in a patient with a craniotomy defect has been reported ( 60 ). Temporary dizziness, injection site soreness, focal alopecia, and paresthesia due to nerve injury should be anticipated ( 61 - 63 ).…”

Section: Potential Complications and Red Flagsmentioning

confidence: 99%

Neuralgias of the Head: Occipital Neuralgia

2016

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Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.

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“…In experimental rats, the intracerebral injection of tetrodotoxin induced a similar pupillary response [ 5 ]. Okuda et al [ 6 ] reported a case of seizure caused by an incidental subarachnoid space injection. Unlike our case, the patient experienced general discomfort and nausea as well as loss of consciousness immediately after a lesser occipital nerve block, using 0.5 ml 1% mepivacaine.…”

Section: Discussionmentioning

confidence: 99%

Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient -a case report-

Lee

Kim

Bae

et al. 2018

Korean J Anesthesiol

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A 34-year-old man who previously underwent a craniotomy due to oligodendroglioma was admitted with a diagnosis of recurrent brain tumor. An awake craniotomy was planned. Approximately 15 minutes after completing the scalp nerve block, his upper torso suddenly moved and trembled for 10 seconds, suggesting a generalized clonic seizure. He recovered gradually and fully in 55 minutes without any neurological sequelae. The emergency computed tomography scan revealed a localized fluid collection and small intracerebral hemorrhage nearby in the temporoparietal cortex beneath the skull defect. He underwent surgery under general anesthesia at 8 hours after the seizure and was discharged from the hospital after 10 days. This report documents the first case of generalized seizure that was caused by the accidental intracerebral injection of local anesthetics. Although the patient recovered completely, the clinical implications regarding the scalp infiltration technique in a patient with skull defects are discussed.

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Sudden unconsciousness during a lesser occipital nerve block in a patient with the occipital bone defect

Cited by 31 publications

References 15 publications

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

Neuralgias of the Head: Occipital Neuralgia

Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient -a case report-

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