ABSTRACT
Presentamos el caso de una gestante que solicitó analgesia epidural durante el trabajo de parto, con cateterización difícil del espacio epidural (múltiples punciones) y posteriormente expulsivo muy dilatado en el tiempo en camilla obstétrica. En el postparto inmediato desarrolló un cuadro de disestesias y debilidad en miembros inferiores. El seguimiento de la paciente y el estudio clínico, neurofisiológico y genético llevaron al diagnóstico de neuropatía sensible a la presión o neuropatía tomacular. Ésta es una enfermedad hereditaria que afecta a la mielina periférica, se caracteriza por episodios recidivantes de neuropatía desmielinizante focal tras traumatismos mínimos o compresión de nervios periféricos. Está probablemente infradiagnosticada, siendo muy escasas las referencias que en la literatura la relacionan con la anestesia(AU)
We report the case of a woman who requested epidural analgesia for labor in whom catheterization of the epidural space was difficult, requiring multiple punctures; furthermore, the epidural block was followed by a long expulsion phase in the delivery room. Shortly after delivery the patient experienced paresthesia and weakness in her lower limbs. A diagnosis of pressuresensitive, or tomaculous neuropathy was based on clinical observation and neurophysiologic and genetic studies. This hereditary disease, which affects peripheral nerve myelin, involves recurrent episodes of focal demyelination when nerves are injured slightly or compressed. This condition is probably underdiagnosed, as there are very few references to it in the literature on anesthesia(AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Hereditary Sensory and Autonomic Neuropathies/drug therapy , Anesthesia, Conduction/instrumentation , Anesthesia, Conduction/methods , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Electrophysiology/instrumentation , Electrophysiology/methods , Hypesthesia/complications , Anesthesia, Epidural/trends , Anesthesia, Epidural , Paresthesia/complications , Paresthesia/therapy , Risk Factors , Pregnancy Complications/prevention & control , Pregnancy Complications/therapyABSTRACT
We report the case of a woman who requested epidural analgesia for labor in whom catheterization of the epidural space was difficult, requiring multiple punctures; furthermore, the epidural block was followed by a long expulsion phase in the delivery room. Shortly after delivery the patient experienced paresthesia and weakness in her lower limbs. A diagnosis of pressure-sensitive, or tomaculous neuropathy was based on clinical observation and neurophysiologic and genetic studies. This hereditary disease, which affects peripheral nerve myelin, involves recurrent episodes of focal demyelination when nerves are injured slightly or compressed. This condition is probably underdiagnosed, as there are very few references to it in the literature on anesthesia.
Subject(s)
Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/adverse effects , Delivery, Obstetric , Nervous System Diseases/etiology , Adult , Female , Humans , Nervous System Diseases/genetics , PressureSubject(s)
Anesthesia, Spinal/adverse effects , Meningitis, Listeria/etiology , Female , Humans , Middle AgedABSTRACT
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