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Anesth Analg 2006;102:1865-1866
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000217117.77826.dd

REGIONAL ANESTHESIA

Divergence Paresis Without Positional Headache: An Unusual Presentation of Cerebrospinal Fluid Hypovolemia After Spinal Anesthesia

Motomi Arai, MD, PhD, Satoko Matsushima, MD, and Hiroshi Terada, MD

Departments of Neurology and Ophthalmology, Seirei Mikatahara General Hospital; Choseido Terada Clinic, Hamamatsu, Japan.

Address correspondence and reprint requests to Motomi Arai, MD, Department of Neurology, Seirei Mikatahara General Hospital, Mikatahara-cho 3453, Hamamatsu, Shizuoka 433-8558, Japan. Address e-mail to arai-m{at}sis.seirei.or.jp.

We report a rare complication of spinal anesthesia—divergence paresis—which is characterized by an acquired horizontal diplopia at distance without evidence for abducens palsy. A 64-yr-old man underwent prostatectomy under spinal anesthesia with 2.5 mL of dibucaine hydrochloride 0.3% injected through a 20-gauge cutting-tip spinal needle. Seventeen days after the operation, the patient noticed horizontal diplopia for distant objects. Although cranial magnetic resonance imaging demonstrated diffuse pachymeningeal gadolinium enhancement and subdural effusion, characteristic findings of cerebrospinal fluid hypovolemia, the patient had no positional headache. Gadolinium-enhanced magnetic resonance imaging may be useful when a patient develops neurologic symptoms after dural puncture.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.