Coma after spinal anaesthesia in a patient with an unknown intracerebral tumour.
Spinal anaesthesia is contraindicated in patients with elevated intracranial pressure or space-occupying intracranial lesions. Drainage of the lumbar cerebrospinal fluid (CSF) can increase the pressure gradient between the spinal, supratentorial and infratentorial compartments. This can result in rapid herniation of the brain stem or occluding hydrocephalus. We present a case of a female patient with an occult brain tumour who received a spinal anaesthesia for an orthopaedic procedure. The primary course of anaesthesia was uneventful. Several hours after surgery, the patient became increasingly disoriented and agitated. The next day, she was found comatose. A computed tomogram of the head revealed herniation of the brain stem, resulting in an occluding hydrocephalus due to a prior not known infratentorial mass. By acute relieving of the intracranial pressure by external CSF drainage, the mass was removed 2 days later. The further post-operative course was uneventful and the patient was discharged from the hospital without neurological deficit 3 weeks after the primary surgery.
Metterlein
T
T
Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. tom.metterlein@gmx.net
Kuenzig
H
H
Bele
S
S
Brawanski
A
A
Graf
B M
BM
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000150:complications*; D003128:Coma / Q000209:etiology*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications