ABSTRACT
Patients treated with long-term spinal infusion of high doses of morphine develop a granuloma at the location of the catheter tip. Diagnosis is based on a steady increase in intrathecal morphine dosage after a relatively prolonged period of stability, on the gradual development of neurologic signs and symptoms suggesting radicular or spinal cord compression, and on magnetic resonance images. We describe a man with central neuropathic pain after removal of a tumor. The presence of all 3 of the aforementioned diagnostic criteria led to suspicion of a spinal granuloma.
Subject(s)
Analgesia, Epidural/instrumentation , Analgesics, Opioid/therapeutic use , Back Pain/etiology , Catheterization/adverse effects , Clonidine/therapeutic use , Granuloma, Foreign-Body/etiology , Infusion Pumps, Implantable/adverse effects , Morphine/therapeutic use , Muscle Relaxants, Central/therapeutic use , Neuralgia/etiology , Postoperative Complications/etiology , Spinal Cord Compression/etiology , Analgesics, Opioid/administration & dosage , Clonidine/administration & dosage , Drug Therapy, Combination , Emergencies , Granuloma, Foreign-Body/surgery , Hemangioma, Cavernous, Central Nervous System/surgery , Humans , Infusions, Parenteral/instrumentation , Laminectomy , Male , Middle Aged , Morphine/administration & dosage , Muscle Relaxants, Central/administration & dosage , Postoperative Complications/drug therapy , Postoperative Complications/surgery , Spinal Cord Compression/surgery , Spinal Cord Diseases/surgeryABSTRACT
Los pacientes en tratamiento con infusión espinal demorfina a dosis elevadas presentan como efecto adversoa largo plazo la formación de un granuloma en la puntadel catéter intradural. La subida ininterrumpida de lasdosis de morfina intratecales tras un periodo relativamenteprolongada de estabilidad, la aparición progresivade una sintomatología neurológica característica decompresión radicular o medular, y las imágenes de resonanciamagnética llevan al diagnóstico de este fenómeno.Se presenta un caso clínico de un paciente con dolor neuropáticocentral tras exéresis tumoral, que reúne los tresprincipios mencionados que llevan al diagnóstico de sospechade granuloma intradural (AU)
Patients treated with long-term spinal infusion of highdoses of morphine develop a granuloma at the locationof the catheter tip. Diagnosis is based on a steadyincrease in intrathecal morphine dosage after arelatively prolonged period of stability, on the gradualdevelopment of neurologic signs and symptomssuggesting radicular or spinal cord compression, and onmagnetic resonance images. We describe a man withcentral neuropathic pain after removal of a tumor. Thepresence of all 3 of the aforementioned diagnosticcriteria led to suspicion of a spinal granuloma (AU)
