Abstracts
An unusual case of Homer's syndrome secondary to a sympathetic block in a patient with chronic adhesive arachnoiditis (CAA) is described. The patient, a 40-year-old white woman, presented with spastic paraplegia, hyperreflexia, bilateral Babinski sigh, superficial and deep sensitive hypoaesthesia at the T4 level, in addition to bladder and rectal dysfunction since she was 32. At age of 38 she complained of excessive daily sweating below the T4 level, mostly at night. A 4mL 0.5% bupivacaine lumbar sympathetic block was performed. Within 15 min aright brachial paresis and an ipsilateral Horner's syndrome were noted. Speculatively, an abnormal cephalic spread of the anaesthesic due to a putative erratic space secondary to the CAA may justify the clinical picture even using a relatively small amount of anaesthesic (4 mL).
lumbar sympathetic block; chronic adhesive arachnoiditis; Horner's syndrome
Os autores descrevem o caso de uma mulher branca de 40 anos de idade, com paraplegia espástica, hiperreflexia, sinal de Babinski bilateral, hipoestesia superficial e profunda em T4, além de incontinência fecal e urinária, desde os 32 anos decorrente de aracnoidite crônica adesiva (CAA). Aos 38 anos passou apresentar sudorese excessiva com limite superior em T4, diária, com intensificação noturna. Um bloqueio simpático lombar foi efetuado com 4mL de bupivacaina 0.5%. Quinze minutos depois a paciente apresentou monoparesia braquial direita e síndrome de Horner ipsolateral. Devido provavelmente a um espaço peridural estreito e errático, secundário à CAA, pode-se justificar o quadro clínico como secundário à ascenção cranial do anestésico, mesmo utilizado em reduzida quantidade (4mL).
bloqueio simpático lombar; aracnoidite crônica adesiva; síndrome de Horner
Horner's syndrome and brachial paresis as a complication of lumbar sympathetic block. A case report
Síndrome de Horner e paresia braquial como complicação de bloqueio simpático lombar: relato de caso
Pa. Maranhão-FilhoI; M.A.O. MartinsII; H.F. LopesIII
INeurologist. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil
IIAnaesthesiologist. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil
IIINeurosurgeon. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil
SUMMARY
An unusual case of Homer's syndrome secondary to a sympathetic block in a patient with chronic adhesive arachnoiditis (CAA) is described. The patient, a 40-year-old white woman, presented with spastic paraplegia, hyperreflexia, bilateral Babinski sigh, superficial and deep sensitive hypoaesthesia at the T4 level, in addition to bladder and rectal dysfunction since she was 32. At age of 38 she complained of excessive daily sweating below the T4 level, mostly at night. A 4mL 0.5% bupivacaine lumbar sympathetic block was performed. Within 15 min aright brachial paresis and an ipsilateral Horner's syndrome were noted. Speculatively, an abnormal cephalic spread of the anaesthesic due to a putative erratic space secondary to the CAA may justify the clinical picture even using a relatively small amount of anaesthesic (4 mL).
Key words:lumbar sympathetic block, chronic adhesive arachnoiditis, Horner's syndrome.
RESUMO
Os autores descrevem o caso de uma mulher branca de 40 anos de idade, com paraplegia espástica, hiperreflexia, sinal de Babinski bilateral, hipoestesia superficial e profunda em T4, além de incontinência fecal e urinária, desde os 32 anos decorrente de aracnoidite crônica adesiva (CAA). Aos 38 anos passou apresentar sudorese excessiva com limite superior em T4, diária, com intensificação noturna. Um bloqueio simpático lombar foi efetuado com 4mL de bupivacaina 0.5%. Quinze minutos depois a paciente apresentou monoparesia braquial direita e síndrome de Horner ipsolateral. Devido provavelmente a um espaço peridural estreito e errático, secundário à CAA, pode-se justificar o quadro clínico como secundário à ascenção cranial do anestésico, mesmo utilizado em reduzida quantidade (4mL).
Palavras Chave: bloqueio simpático lombar, aracnoidite crônica adesiva, síndrome de Horner.
Texto completo disponível apenas em PDF.
Full text available only in PDF format.
Aknowledgement - We are indebted to Dr. Maurice Vincent for assistance.in preparing this manuscript.
Aceite: ll-maio-1995.
Dr. Péricles A. Maranhão Filho, - Av. Canal de Marapendi 1680 apt 1802. - 22631-050 Rio de Janeiro RJ -Brasil. Fax (+55.21) 4395594.
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Publication Dates
-
Publication in this collection
08 Dec 2010 -
Date of issue
Dec 1995
