Letter to the Editor
VI cranial nerve palsy following epidural anaesthesia
Paresia del VI par craneal tras anestesia epidural
L. Pulido Fontes
, N. Aymerich, L. Martínez
Corresponding author
Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain
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Pulido Fontes, N. Aymerich, L. Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Pulido Fontes" "email" => array:1 [ 0 => "lpfontes7@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Aymerich" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paresia del VI par craneal tras anestesia epidural" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 951 "Tamanyo" => 211167 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI FLAIR sequence. Homogeneous dural enhancement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It was with great interest that we read the article published by E. Durán Ferreras analysing the complications of epidural anaesthesia with reference to a case in which VI cranial nerve palsy (CNP) developed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The doctor presents an excellent review of the history of complications that have been described after lumbar puncture (LP), the physiopathological mechanisms that may be involved, and a description of the most common clinical presentations. The article suggests conservative treatment measures including rest, hydration, and analgesia. In many cases, this approach delivers spontaneous resolution of symptoms at some point between 2 weeks and more than 3 months. It also describes use of epidural blood patches which give mixed results, depending on how soon they are used after symptom onset.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We recently treated a patient whose clinical description was similar to that in the cited article. She had an excellent response to treatment with an epidural blood patch given 72 hours after onset of diplopia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This 35-year-old female received an epidural during childbirth; on the following day, she experienced an intense generalised headache that intensified in a vertical position and improved upon lying down, accompanied by nausea and pain in the nuchal area. Doctors immediately employed conservative treatment measures with rest, hydration, and analgesics (metamizole<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>codeine, NSAIDs); the patient improved somewhat, and the doctors decided to discharge her. The patient was readmitted 5 days later due to recurrence of a similar headache and appearance of double vision when gazing to the right. Examination showed right VI CNP with no other changes. It was at that time that our department was contacted and the patient referred for care in our centre. An MRI scan (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) revealed findings compatible with cerebrospinal fluid hypotension; bilateral subdural hygromas were present. As the headache and diplopia persisted despite hydration and analgesia, we consulted with the anaesthesiology division and decided to treat with a 20<span class="elsevierStyleHsp" style=""></span>cc autologous blood patch at 72 hours after onset of VI CNP. The patient's headache and diplopia both improved gradually in the 24 hours following the procedure. The patient was discharged 72 hours after treatment, at which time the diplopia had abated and she was able to stand without experiencing further headaches.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Although most published cases report complete and spontaneous resolution of VI CNP after LP within several weeks or even months after onset of the deficit, there are also other cases that do not progress well and require more aggressive treatment, including surgical treatment.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Diplopia and headache are debilitating symptoms that limit patients’ daily life activities and require use of the most effective treatment possible. The literature states that autologous blood patches are only effective for cases of post-LP headaches and diplopia in which treatment is initiated in the first 24 hours after VI CNP appears.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> The interesting feature of this case is that treatment delivered excellent results even though the epidural blood patch was administered 72 hours after palsy onset.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, we would like to suggest considering treatment with an epidural blood patch even when more than 24 hours have passed since the onset of CNP. This treatment may significantly accelerate the patient's recovery.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pulido Fontes L, et al. Paresia del VI par craneal tras anestesia epidural. Neurología. 2012;27:442–3.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 951 "Tamanyo" => 211167 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI FLAIR sequence. Homogeneous dural enhancement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1068 "Ancho" => 951 "Tamanyo" => 197506 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI FLAIR sequence. Bilateral subdural hygromas.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paresia del VI par tras anestesia epidural" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. 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Dolbec" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03022012" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2007" "volumen" => "54" "paginaInicial" => "146" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17272255" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000002700000007/v1_201305151340/S2173580812001484/v1_201305151340/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000002700000007/v1_201305151340/S2173580812001484/v1_201305151340/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001484?idApp=UINPBA00004N" ]
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| 2023 February | 52 | 6 | 58 |
| 2023 January | 34 | 9 | 43 |
| 2022 December | 34 | 4 | 38 |
| 2022 November | 54 | 18 | 72 |
| 2022 October | 38 | 8 | 46 |
| 2022 September | 40 | 9 | 49 |
| 2022 August | 40 | 9 | 49 |
| 2022 July | 35 | 10 | 45 |
| 2022 June | 27 | 10 | 37 |
| 2022 May | 31 | 14 | 45 |
| 2022 April | 34 | 9 | 43 |
| 2022 March | 36 | 8 | 44 |
| 2022 February | 30 | 7 | 37 |
| 2022 January | 49 | 9 | 58 |
| 2021 December | 34 | 9 | 43 |
| 2021 November | 26 | 6 | 32 |
| 2021 October | 39 | 13 | 52 |
| 2021 September | 30 | 11 | 41 |
| 2021 August | 37 | 5 | 42 |
| 2021 July | 19 | 8 | 27 |
| 2021 June | 27 | 10 | 37 |
| 2021 May | 23 | 8 | 31 |
| 2021 April | 55 | 10 | 65 |
| 2021 March | 22 | 5 | 27 |
| 2021 February | 16 | 8 | 24 |
| 2021 January | 13 | 20 | 33 |
| 2020 December | 13 | 12 | 25 |
| 2020 November | 32 | 4 | 36 |
| 2020 October | 8 | 7 | 15 |
| 2020 September | 13 | 7 | 20 |
| 2020 August | 12 | 11 | 23 |
| 2020 July | 15 | 14 | 29 |
| 2020 June | 14 | 4 | 18 |
| 2020 May | 9 | 9 | 18 |
| 2020 April | 7 | 3 | 10 |
| 2020 March | 9 | 4 | 13 |
| 2020 February | 16 | 3 | 19 |
| 2020 January | 16 | 3 | 19 |
| 2019 December | 19 | 3 | 22 |
| 2019 November | 5 | 11 | 16 |
| 2019 October | 12 | 6 | 18 |
| 2019 September | 4 | 3 | 7 |
| 2019 August | 7 | 5 | 12 |
| 2019 July | 11 | 16 | 27 |
| 2019 June | 23 | 24 | 47 |
| 2019 May | 82 | 46 | 128 |
| 2019 April | 29 | 12 | 41 |
| 2019 March | 4 | 4 | 8 |
| 2019 February | 10 | 5 | 15 |
| 2019 January | 2 | 2 | 4 |
| 2018 December | 2 | 5 | 7 |
| 2018 November | 1 | 1 | 2 |
| 2018 October | 11 | 9 | 20 |
| 2018 September | 4 | 2 | 6 |
| 2018 August | 9 | 3 | 12 |
| 2018 July | 6 | 3 | 9 |
| 2018 June | 5 | 3 | 8 |
| 2018 May | 10 | 2 | 12 |
| 2018 April | 5 | 2 | 7 |
| 2018 March | 6 | 0 | 6 |
| 2018 January | 5 | 2 | 7 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 5 | 2 | 7 |
| 2017 October | 11 | 1 | 12 |
| 2017 September | 9 | 1 | 10 |
| 2017 August | 16 | 1 | 17 |
| 2017 July | 19 | 3 | 22 |
| 2017 June | 15 | 3 | 18 |
| 2017 May | 10 | 6 | 16 |
| 2017 April | 7 | 8 | 15 |
| 2017 March | 9 | 11 | 20 |
| 2017 February | 1 | 4 | 5 |
| 2017 January | 10 | 3 | 13 |
| 2016 December | 5 | 5 | 10 |
| 2016 November | 10 | 1 | 11 |
| 2016 October | 23 | 7 | 30 |
| 2016 September | 16 | 8 | 24 |
| 2016 August | 31 | 3 | 34 |
| 2016 July | 15 | 1 | 16 |
| 2016 June | 21 | 7 | 28 |
| 2016 May | 10 | 13 | 23 |
| 2016 April | 20 | 11 | 31 |
| 2016 March | 31 | 21 | 52 |
| 2016 February | 17 | 16 | 33 |
| 2016 January | 13 | 10 | 23 |
| 2015 December | 12 | 5 | 17 |
| 2015 November | 18 | 15 | 33 |
| 2015 October | 23 | 15 | 38 |
| 2015 September | 17 | 10 | 27 |
| 2015 August | 30 | 5 | 35 |
| 2015 July | 27 | 9 | 36 |
| 2015 June | 10 | 1 | 11 |
| 2015 May | 16 | 2 | 18 |
| 2015 April | 21 | 12 | 33 |
| 2015 March | 25 | 6 | 31 |
| 2015 February | 19 | 8 | 27 |
| 2015 January | 33 | 7 | 40 |
| 2014 December | 36 | 11 | 47 |
| 2014 November | 17 | 2 | 19 |
| 2014 October | 26 | 7 | 33 |
| 2014 September | 29 | 1 | 30 |
| 2014 August | 34 | 7 | 41 |
| 2014 July | 45 | 4 | 49 |
| 2014 June | 25 | 4 | 29 |
| 2014 May | 18 | 4 | 22 |
| 2014 April | 12 | 3 | 15 |
| 2014 March | 20 | 2 | 22 |
| 2014 February | 21 | 3 | 24 |
| 2014 January | 15 | 3 | 18 |
| 2013 December | 38 | 1 | 39 |
| 2013 November | 27 | 3 | 30 |
| 2013 October | 24 | 7 | 31 |
| 2013 September | 26 | 3 | 29 |
| 2013 August | 40 | 3 | 43 |
| 2013 July | 20 | 1 | 21 |
Show all
