Two cases of chemical meningitis following spinal anesthesia

Abstract

within the hospital. A puncture was made without any difficulty between L3 and L4 by using a disposable 25G needle for spinal anesthesia, and 2 ml of 0.3% dibucaine HCl was injected by using a 5-ml glass syringe that had been sterilized in the hospital. At the completion of the surgical procedure, the patient experienced mild nausea. In the ward 3 h after spinal anesthesia, she developed nausea, headache, a slight fever, and chills. Five hours later, her temperature returned to 37.6°C.A neurological examination was conducted the next day, and no abnormalities of the cranial nerves were recognized; however, headache, nuchal rigidity, and positive Kernig sign were noted. Hematological examination revealed an inflammatory state (white blood cell count, 9990 · mm Ϫ3 ; C-reactive protein, 2.6 mg·dl Ϫ1 ). The results of a lumbar puncture indicated the following: cerebrospinal fluid, slightly turbid; initial pressure, 175 mmH 2 0; cell counts 664/3 mm 3 (poly, 400 and mono, 264); protein, 152 mg·dl Ϫ1 ; sugar, 57 mg·dl Ϫ1 . The patient was treated with piperacillin sodium for 8 days under the diagnosis of meningitis. The cerebrospinal fluid culture yielded no bacterial growth. On the fifth day, she no longer suffered from neurological sequelae and was considered to have recovered completely. Case 2At 12 weeks and 6 days of pregnancy, a 24-year-old woman with cervical incompetence that had been caused by cervical conization was scheduled to undergo cervical cerclage under spinal anesthesia to prevent premature labor. Following handwashing and disinfection, the anesthetic procedure was performed in the same way as in Case 1 using the same drug and equipment set.Throughout the surgical procedure and after the patient was returned to the ward, no changes in vital signs were noted and she reported no subjective symptoms. However, nausea and vomiting developed 90 min and headache 2 h after spinal anesthesia. Twelve hours after

Aseptic meningitis after intrathecal baclofen injection

“…The most frequent cases were observed with isotope cisternography, 14,15 intrathecal corticosteroid injections (hydrocortisone acetate, methylprednisolone acetate [16][17][18][19][20] and methylprednisolone in a polyethylene glycol vehicle (Depomedrol s ) 21 ), aminoglycosides 22 and spinal anesthetics. 23,24 This led Merritt and Fremont-Smith to the conclusion that intrathecal injection of 'any foreign material may cause aseptic meningitis'.…”