Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome
Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome
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DOI：
10.1016/j.ijoa.2009.05.007
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发表时间：
2010-01-01
影响因子：
2.8
通讯作者：
Murata, Y.
中科院分区：
文献类型：
--
作者：
Koyama, S.;Tomimatsu, T.;Murata, Y.
本文报告一例HELLP综合征患者在腰麻剖宫产术后发生蛛网膜下腔血肿。一名39岁的妇女在脊髓麻醉下接受剖宫产术，以治疗恶化的先兆子痫伴HELLP综合征。尽管从脊髓麻醉中完全恢复，但在术后第二天，她感到右腿后部麻木，注意到她对膀胱充盈不敏感，并有轻度弛缓性下肢轻瘫。磁共振成像显示脊髓蛛网膜下腔血肿伴马尾压迫。经过保守治疗，她在三个月内几乎完全康复。连续磁共振成像显示血肿自发消退。产科区域麻醉后脊髓蛛网膜下腔血肿的风险非常小，即使在凝血功能障碍的患者中，据我们所知，这只是产科区域麻醉后报告的第二例病例。血小板计数充足但无弥散性血管内凝血的HELLP综合征患者的麻醉方法存在争议。因此，临床医生必须认识到脊髓蛛网膜下腔血肿的症状和体征，以避免延误治疗，可能导致严重的神经功能缺损。(C)2009爱思唯尔有限公司版权所有。
A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, oil the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obstetric regional anesthesia is exceedingly small even in a patient with coagulopathy and, to our knowledge, this is only the second reported case following obstetric regional anesthesia. Anesthesia for HELLP syndrome in patients with ail adequate platelet count but without disseminated intravascular coagulation is controversial. It is therefore important for clinicians to recognize the symptoms and signs of spinal subarachnoid hematoma to avoid delay in treatment that might result in severe neurological deficit. (C) 2009 Elsevier Ltd. All rights reserved.