[Neurological complications of peri-spinal block in regional anesthesia]. / Complicaciones neurológicas de los bloqueos perimedulares en anestesia regional.

INTRODUCTION: A perispinal block (intradural and/or epidural) is a technique which is considered to be safe under certain conditions. Nevertheless, neurological complications are possible and may be associated with transient or permanent sequelae, as is shown by symptoms ranging from minor alterations (most commonly) to major neurological defects (rarely). DEVELOPMENT: In this article we describe a review of the bibliography on physiopathological mechanisms (ischaemia, compression, trauma per se, neurotoxicity of the anesthetic drugs and infection), and also the risk factors associated with the development of these complications. CONCLUSION: Knowledge permits the use of a series of preventive measures to be followed before, during and after carrying out the technique.

[Hyponatremia in the postoperative period after a neurosurgical tumor condition]. / Hiponatremia en el postoperatorio de la patología tumoral neuroquirúrgica.

A four-year-old girl suffered difficult-to-diagnose hyponatremia resistant to treatment following surgery for a suprasellar tumor. The final diagnosis was diabetes insipidus evolving in three stages. Hyponatremia is a common problem following surgery to remove brain tumors. Early diagnosis and treatment of this electrolytic imbalance are essential for preventing serious neurological symptoms or death. The conditions most closely related to hyponatremia are inappropriate antidiuretic hormone secretion syndrome (IADHSS) and cerebral salt wasting syndrome (CSWS). The latter has become more common in recent years among patients undergoing brain surgery. Whereas IADHSS is treated by restricting fluids, CSWS requires administration of salt and volume fluid volume. We believe that for differential diagnosis of postoperative hyponatremia, a fluid restriction test takes priority over of fluid loading following neurosurgery. The course of hyponatremia must be carefully monitored and a complete endocrinological workup must be performed to detect the possible presence of hypophyseal deficiencies, particularly hypothyroidism and suprarenal insufficiency.