Bilateral sixth cranial nerve palsy after unintentional dural puncture.
OBJECTIVE
Bilateral sixth nerve palsy is a known though uncommon complication following dural puncture. The recommended treatment consists of hydration and alternate monocular occlusion. The value and the timing of an epidural blood patch (EBP) for sixth nerve palsy remains controversial as some authors have demonstrated benefits in performing an EBP early in course of the nerve palsy whereas others have not found any advantage when an EBP was performed later.


METHODS
A 40-yr-old woman developed bilateral sixth nerve palsy ten days after an unintentional dural puncture. An EBP was done within 24 hr after the onset of the symptoms and immediate improvement of the diplopia was noted by the patient and confirmed by an ophthalmologist. Complete resolution of the diplopia occurred 36 days after the dural puncture.


CONCLUSIONS
Blood patching within 24 hr of the onset of diplopia may be a reasonable treatment for ocular nerve palsy as it relieved the postdural puncture headache and produced partial improvement of the diplopia.
Department of Anesthesiology, CHUM, Notre-Dame Hospital, Montréal, Québec, Canada.
Geneviève
G
Arcand
François
F
Girard
Michael
M
McCormack
Philippe
P
Chouinard
Daniel
D
Boudreault
Stephan
S
Williams
D015746:Abdominal Pain / Q000150:complications; D020434:Abducens Nerve Diseases / Q000209:etiology* / Q000628:therapy*; D000328:Adult; D000732:Androstanols / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D017217:Blood Patch, Epidural / Q000379:methods; D002045:Bupivacaine / Q000627:therapeutic use; D004172:Diplopia / Q000150:complications / Q000628:therapy; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D019300:Medical Errors / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D015742:Propofol / Q000627:therapeutic use; D000077123:Rocuronium; D001750:Urinary Bladder, Neurogenic / Q000601:surgery
D000732:Androstanols; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D003473:Neuromuscular Nondepolarizing Agents; D005283:Fentanyl; D000077123:Rocuronium; D002045:Bupivacaine; D015742:Propofol