ABSTRACT
A 28 year old woman, ASA I, who, in the final stages of her pregnancy presented with signs of neural deficit that consisted of distortion of the oral commissure, dysphagia, dysarthria, and weakness on the left side of the body. She was diagnosed with thrombosis in a segment of the right middle cerebral artery which led to an ischemic area in the right frontal lobe. Termination of pregnancy and conservative treatment was decided, with good resolution of the symptoms.
Subject(s)
Infarction, Middle Cerebral Artery/diagnosis , Pregnancy Complications, Cardiovascular/diagnosis , Adult , Anticoagulants/therapeutic use , Brain Ischemia/diagnostic imaging , Brain Ischemia/drug therapy , Brain Ischemia/etiology , Carotid Artery Thrombosis/diagnosis , Carotid Artery Thrombosis/diagnostic imaging , Cesarean Section , Computed Tomography Angiography , Conservative Treatment , Female , Frontal Lobe/blood supply , Frontal Lobe/diagnostic imaging , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Imaging, Three-Dimensional , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/drug therapy , Magnetic Resonance Angiography , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Pregnancy , Thrombophilia/geneticsABSTRACT
The case is presented of a 42 year old woman who had been suffering a loss of strength in her left leg for six years. After an extensive diagnostic study, the pain was classified as of functional origin by a diagnosis of exclusion. Since then, the patient has tried all kind of drug treatments and conservative techniques without improvement. After an exhaustive study with inconclusive results, the case was discussed with the Orthopaedics Department, who performed an exploratory surgery, in which compression of the sciatic nerve due to an anatomical variation of the piriformis muscle was observed. Part of the muscle was resected during surgery and the sciatic nerve was freed, after which the patient experienced a great improvement.
Subject(s)
Muscle, Skeletal/abnormalities , Piriformis Muscle Syndrome/etiology , Sciatica/etiology , Adrenal Cortex Hormones/therapeutic use , Adult , Anesthetics, Local/therapeutic use , Decompression, Surgical , Diagnostic Techniques, Neurological , Female , Humans , Injections, Intramuscular , Mobility Limitation , Paresthesia/etiology , Piriformis Muscle Syndrome/diagnosis , Piriformis Muscle Syndrome/pathology , Piriformis Muscle Syndrome/surgery , Sciatica/pathologyABSTRACT
A 45-year-old woman was accidentally administered an epidural infusion of paracetamol instead of levobupivacaine for postoperative pain therapy during the postoperative period of abdominal hysterectomy under general anesthesia combined with epidural analgesia. The patient had no neurological symptoms at any time, although a slight tendency to arterial hypotension that did not require treatment was observed. No rescue analgesia was necessary until 8h after the start of epidural infusion. The incidence of these types of errors is probably underestimated, although there are several cases reported with various drugs.
