Central sensory-motor deficit after uneventful single-dose spinal morphine administration in a patient with preexisting migraine headaches.
Hemiplegic migraine is a condition associated with vascular alteration of the central nervous system and transient neurologic deficits. Permanent morphine-induced motor dysfunction has been reported after spinal ischemia. We report a persisting central neurological deficit after single-dose spinal administration of 400 microg of morphine in a patient with no previous neurological condition. Hemiplegic migraine was thought to be present when the patient emerged from anesthesia. Weakness in the left quadriceps and saddle anesthesia of the perineum and urinary retention of central origin remained present 3 yr later. Over the 3 postoperative years, the patient was admitted to a neurological unit 5 times because of acute headache associated with complete left-sided hemiplegia. These symptoms resolved within 24 h of onset. Hemiplegic migraine was thought to be the most likely diagnosis of these recurrent attacks. We hypothesize that the patient's persistent deficits were caused by a combination of spinal morphine and spinal cord vascular dysfunction associated with hemiplegic migraine.
Department of Anesthesia and Critical Care, Faculté de Médecine, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France. claude.lentschener@cch.aphp.f.
Claude
C
Lentschener
Bertrand
B
Dousset
Mathieu
M
Zuber
Yves
Y
Ozier
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D013505:Digestive System Surgical Procedures; D004715:Endometriosis / Q000150:complications / Q000601:surgery; D005260:Female; D006429:Hemiplegia / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007278:Injections, Spinal; D020325:Migraine with Aura / Q000150:complications*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D010052:Ovariectomy; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology; D011597:Psychomotor Performance / Q000187:drug effects*; D052097:Quadriceps Muscle / Q000294:innervation; D012008:Recurrence; D013116:Spinal Cord / Q000098:blood supply; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000503:physiopathology
D000701:Analgesics, Opioid; D009020:Morphine