Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.06.007
Brazilian Journal of Anesthesiology
Clinical Information

Cerebellar infarct following orchidopexy under spinal anesthesia

Infarto cerebelar após orquidopexia sob raquianestesia

Sunny Goel; Gaurav Garg; Manoj Kumar; Ruchir Aeron

http://dx.doi.org/10.1016/j.bjane.2018.06.007 Braz J Anesthesiol, vol.69, n1, p.109-112, 2019
PDF English
PDF Português
Downloads: 0
Views: 607

Abstract

Abstract The report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75 mg.day-1, following which his vision started improving after 2 weeks. Possible mechanisms of development of stroke in the peri-operative period are discussed, but, even after extensive investigations, the etiology of infarct may be difficult to determine. Acute infarct after elective non-cardiac, non-neurological surgery is rare; it may not be possible to identify the etiology in all cases. Clinicians must have a high index of suspicion to diagnose such unexpected complications even after routine surgical procedures in order to decrease the morbidity and long term sequelae.

Keywords

Ischemia, Stroke, Orchidopexy, Spinal anestesia

Resumo

Resumo O presente relato descreve um caso de acidente vascular cerebral perioperatório que resultou em diplopia e dificuldade de marcha no segundo dia após orquidopexia de rotina sob raquianestesia em um jovem, em outros aspectos, saudável. Ressonância magnética cerebral revelou infarto agudo em hemisférios cerebelares bilaterais, metade esquerda do bulbo e tálamo esquerdo. Um diagnóstico de acidente vascular cerebral agudo (infarto) foi feito e o paciente começou a receber tratamento com aspirina oral (75 mg.dia-1), após o qual sua visão começou a melhorar após duas semanas. Possíveis mecanismos de desenvolvimento de acidente vascular cerebral no período perioperatório são discutidos, mas, mesmo após extensas investigações, a etiologia do infarto pode ser difícil de determinar. O infarto agudo após cirurgia eletiva não cardíaca e não neurológica é raro; talvez não seja possível identificar a etiologia em todos os casos. Os médicos devem ter um elevado grau de suspeita para diagnosticar essas complicações inesperadas, mesmo após procedimentos cirúrgicos de rotina, para diminuir a morbidade e as sequelas em longo prazo.

Palavras-chave

Isquemia, Acidente vascular cerebral, Orquidopexia, Raquianestesia

References

Ng JL, Chan MT, Gelb AW. Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology. 2011;115:879-90.

Sacco RL, Kasner SE, Broderick JP. An updated definition of stroke for the 21st century. Stroke. 2013;44:2064-89.

Lee HY, Wang HS, Kim SW. Cerebellar infarction following epidural abscess after epidural neuroplasty. Korean J Spine. 2015;12:26-8.

Al-Asmi A, John R, Nandhagopal R. Spinal cord infarction following abdominal surgery and postoperative epidural analgaesia. Sultan Qaboos Univ Med J. 2010;10:396.

Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981;60:150-61.

Brull R, McCartney CJ, Chan VW. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965-74.

Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia. Reg Anesth Pain Med. 1998;23:104-7.

Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172-9.

Mione G, Pische G, Wolff V. Perioperative bioccipital watershed strokes in bilateral fetal posterior cerebral arteries during spinal surgery. World Neurosurg. 2016;85:e17- e21.

Zheng M, Sun A, Sun Q. Clinical and imaging analysis of a cerebellar watershed infarction. Chinese Med. 2015;6:6:54.

5dcafcc70e88250d3e03b87a rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections