RESUMO
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.
Assuntos
Infarto da Artéria Cerebral Média/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Adulto , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/etiologia , Trombose das Artérias Carótidas/diagnóstico , Trombose das Artérias Carótidas/diagnóstico por imagem , Cesárea , Angiografia por Tomografia Computadorizada , Tratamento Conservador , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Imageamento Tridimensional , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Angiografia por Ressonância Magnética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Gravidez , Trombofilia/genéticaRESUMO
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.
Assuntos
Músculo Esquelético/anormalidades , Síndrome do Músculo Piriforme/etiologia , Ciática/etiologia , Corticosteroides/uso terapêutico , Adulto , Anestésicos Locais/uso terapêutico , Descompressão Cirúrgica , Técnicas de Diagnóstico Neurológico , Feminino , Humanos , Injeções Intramusculares , Limitação da Mobilidade , Parestesia/etiologia , Síndrome do Músculo Piriforme/diagnóstico , Síndrome do Músculo Piriforme/patologia , Síndrome do Músculo Piriforme/cirurgia , Ciática/patologiaRESUMO
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.
