ABSTRACT
Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery.
Subject(s)
Cerebellar Diseases/etiology , Cerebellar Diseases/therapy , Intervertebral Disc Displacement/surgery , Intracranial Hemorrhages/therapy , Lumbar Vertebrae/surgery , Postoperative Complications/therapy , Brain/diagnostic imaging , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/etiology , Female , Glasgow Coma Scale , Glasgow Outcome Scale , Humans , Middle Aged , Orthopedic Procedures/adverse effects , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Anesthetics, Intravenous/pharmacology , Brain/growth & development , Neuroprotective Agents , Piperidines/pharmacology , Apoptosis/drug effects , Brain/drug effects , Humans , Infant, Newborn , N-Methylaspartate/physiology , Receptors, N-Methyl-D-Aspartate/drug effects , Receptors, N-Methyl-D-Aspartate/genetics , RemifentanilABSTRACT
Experiments performed in mammals, including non-human primates, have demonstrated an increase in neuronal death rates normally seen in normal brain development. Such an increase is encountered in diseases but also after exposure of the brain to various class of anaesthetics. In living animals, it can (but not always) result in persistent cognitive impairment. Most of the experiments have been conducted in animals which were never exposed to any pain, which questions their relevancy. On the clinical side, all data comes from retrospective studies. Given the multiple bias, they cannot definitely state that a protocol, if toxic, is more or less when compared to another. Until now, prospective follow-up of children exposed to anaesthetics in utero or during the first months of life do not suggest a major deleterious effect. Yet, a minor one, if existing, would be hard to detect among polluting variables (e.g. pathology requiring anaesthesia, long hospitalization after birth, preterm birth, environmental stress...). For sure, when surgery is mandatory during pregnancy, it is generally for maternal indication and should not be a motif strong enough for foetal extraction, especially in terms where the baby has few chances to survive. Second, it is known for years than anaesthesia before 1 year of age is much riskier than after 1 year, whatever the theorical neurotoxicity is. Third, this enforces the need to develop tools enhancing the precision of anaesthesia as much as possible. Meanwhile, when an infant has undergone numerous general anaesthesias, we strongly recommend a long-time neurological follow-up.
Subject(s)
Conscious Sedation/adverse effects , Nervous System Diseases/etiology , Aging/physiology , Anesthetics, General/antagonists & inhibitors , Anesthetics, General/pharmacology , Anesthetics, General/toxicity , Animals , Cesarean Section , Critical Care , Excitatory Amino Acid Agonists/pharmacology , Female , Fetal Alcohol Spectrum Disorders/physiopathology , Humans , Hypnotics and Sedatives/pharmacology , Hypnotics and Sedatives/toxicity , Infant, Newborn , Infant, Premature , Intensive Care Units , N-Methylaspartate/pharmacology , Nervous System Diseases/pathology , Neurotoxicity Syndromes/etiology , Neurotoxicity Syndromes/therapy , Pregnancy , Primates/physiology , Synaptic Transmission/drug effects , Teratogens , gamma-Aminobutyric Acid/pharmacologyABSTRACT
About fifty to sixty percent of patients with septic shock acquire acute adrenal insufficiency. This insufficiency is most often relative, but can sometimes be absolute. Bilateral adrenal haemorrhage is a rare aetiology of absolute acute adrenal insufficiency. It is classically described in patients with severe meningococcemia (purpura fulminans), who commonly present many of the risk factors associated with bilateral adrenal haemorrhage (shock, coagulation disorders, sepsis). We report a case of bilateral adrenal haemorrhage during a peritonitis complicated by a septic shock, with no coagulation disorder. This observation shows up that this bilateral adrenal haemorrhage can complicate severe sepsis of various origins, and not only severe meningococcemia. It can be suspected in face of a septic shock with an unfavourable evolution despite adequate treatment.
