Diplopia: A Complication of Dural Puncture

Case reports of extraocular muscle paralysis (EOMP) were compiled from a computerized search of the medical literature in English, Spanish, French, German, and Japanese from 1966 through December 20, 2002 using PubMed and the OVID search engine. Forty-four related articles were identified, and 41 reports were obtained. Four reports were excluded from the review because of either insufficient descriptions of the cases or confounding factors, such as medicine or underlying disease that could have independently contributed to the EOMP. An additional 12 reports were obtained after hand-searching reference lists of retrieved reports and review articles. A total of 94 reported cases and one of the authors’ own were analyzed for this review article. The reported incidence of EOMP after dural puncture varies from 1 in 400 to 1 in 8000. These incidence reports were either from retrospective reviews of spinal anesthesia in 1947 and 1961 or diagnostic lumbar punctures in which larger spinal needles were often used. Spinal anesthesia was found to be the most frequently reported procedure involved (47%), followed by myelography (18%), diagnostic lumbar puncture (12%), epidural anesthesia/injection (11%), continuous spinal anesthesia (4%), and other dural puncture procedures.

[1]  A. H. Oostdijk,et al.  Subdural hygroma: a rare complication of spinal anesthesia. , 2002, Anesthesia and analgesia.

[2]  E. Trinka,et al.  Abducens palsy after lumbar puncture , 2002, Clinical Neurology and Neurosurgery.

[3]  F. Béïque,et al.  Seizures After Epidural Blood Patch With Undiagnosed Subdural Hematoma , 2002, Regional Anesthesia & Pain Medicine.

[4]  M. Müllner,et al.  Does bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[5]  S. Mikawa,et al.  [Spontaneous intracranial hypotension complicating subdural hematoma: unilateral oculomotor nerve palsy caused by epidural blood patch]. , 2001, No shinkei geka. Neurological surgery.

[6]  J. Seebacher,et al.  Effectiveness of Epidural Blood Patch in the Management of Post–Dural Puncture Headache , 2001, Anesthesiology.

[7]  K. Ikeda,et al.  Vulnerability of the gradually elongated nerve to compression injury. , 2001, Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand.

[8]  V. Pelak,et al.  Palsies of the third, fourth, and sixth cranial nerves. , 2001, Ophthalmology clinics of North America.

[9]  B. Mokri.  Spontaneous intracranial hypotension , 2001, Current neurology and neuroscience reports.

[10]  K. Ikeda,et al.  Experimental study of peripheral nerve injury during gradual limb elongation. , 2000, Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand.

[11]  O. Suess,et al.  Intracranial haemorrhage following lumbar myelography: case report and review of the literature , 2000, Neuroradiology.

[12]  W. Paulus,et al.  Hashimoto encephalopathy: A brainstem vasculitis? , 2000, Neurology.

[13]  D. D. C. Déjardin,et al.  Paresia del VI par tras raquianestesia , 2000 .

[14]  G. Chalkiadis,et al.  Unintentional paediatric subdural catheter with oculomotor and abducens nerve palsies , 1999, Paediatric anaesthesia.

[15]  S. Abram,et al.  Cranial Nerve Palsy and Intracranial Subdural Hematoma Following Implantation of Intrathecal Drug Delivery Device , 1999, Regional Anesthesia & Pain Medicine.

[16]  J. Szokol,et al.  Lack of Efficacy of an Epidural Blood Patch in Treating Abducens Nerve Palsy After an Unintentional Dura Puncture , 1999, Regional Anesthesia & Pain Medicine.

[17]  A. Brioschi,et al.  Transient oculomotor cranial nerves palsy in spontaneous intracranial hypotension. , 1998, Journal of neurosurgical sciences.

[18]  M. Boissier,et al.  Abducens palsy after an intrathecal glucocorticoid injection. Evidence for a role of intracranial hypotension. , 1998, Revue du rhumatisme.

[19]  H. Spencer,et al.  Postdural Puncture Headache: What Matters in Technique , 1998, Regional Anesthesia & Pain Medicine.

[20]  J. Bamford,et al.  Visual problems following dural puncture. , 1998, Postgraduate medical journal.

[21]  J. Cadranel,et al.  Diplopia after peridural and intradural infiltrations of prednisolone. 2 cases , 1997 .

[22]  J. Tsevat,et al.  Economic evaluations of smoking interventions. , 1997, Preventive medicine.

[23]  C. Corney,et al.  Case report: sixth nerve palsy following radiculography. , 1995, The British journal of radiology.

[24]  C. Day,et al.  Auditory, Ocular, and Facial Complications of Central Neural Block: A Review of Possible Mechanisms , 1995, Regional Anesthesia & Pain Medicine.

[25]  J. Bell,et al.  Iatrogenic Lateral Rectus Palsies A Series of Five Postmyelographic Cases , 1994, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.

[26]  Nathaniel Katz,et al.  Failure of delayed epidural blood patching to correct persistent cranial nerve palsies. , 1994, Anesthesia and analgesia.

[27]  H. Böhrer,et al.  Abduzensparesen nach Spinalanästhesie , 1994 .

[28]  J. Villemure,et al.  Abducens Palsy Following Shunting for Hydrocephalus , 1993, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[29]  B. Younge,et al.  Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. , 1992, American journal of ophthalmology.

[30]  P. Martínez-Martín,et al.  Unilateral calcification of the basal ganglia and contralateral hemichorea syndrome , 1991 .

[31]  G. Dierking,et al.  [Abducens paresis, a rare complication to spinal analgesia]. , 1991, Ugeskrift for laeger.

[32]  G. McIlwaine,et al.  Postmyelographic abducent nerve palsy in association with the contrast agent iopamidol. , 1990, Journal of clinical neuro-ophthalmology.

[33]  S. Richer,et al.  Sixth nerve palsy after lumbar anesthesia. , 1989, Optometry and vision science : official publication of the American Academy of Optometry.

[34]  E. JustoFirvida,et al.  Primary hyperparathyroidism in a patient with ulcerative colitis and diabetes mellitus , 1989 .

[35]  M. Pallarés.  Bilateral paralysis of the VI cranial nerves following myelography with metrizamide , 1988 .

[36]  T. A. Thomas,et al.  Posture and post-spinal headache. A controlled trial in 80 obstetric patients. , 1988, British journal of anaesthesia.

[37]  M. Moster,et al.  Isolated sixth-nerve palsies in younger adults. , 1984, Archives of ophthalmology.

[38]  E. Perlman,et al.  Bilateral sixth-nerve palsy after water-soluble contrast myelography. , 1984, Archives of ophthalmology.

[39]  H. Benzon.  Intracerebral hemorrhage after dural puncture and epidural blood patch: nonpostural and noncontinuous headache. , 1984, Anesthesiology.

[40]  P. Salvaing,et al.  [Paralysis of the 6th nerve following peridural anesthesia]. , 1982, Bulletin des societes d'ophtalmologie de France.

[41]  M. Salem,et al.  Persistent sixth cranial nerve paresis following blood patch for postdural puncture headache. , 1982, Anesthesia and analgesia.

[42]  G. Spector,et al.  The pathophysiology of compression injuries of the peripheral facial nerve. , 1982, The Laryngoscope.

[43]  M. Johns,et al.  The clonal assay of head and neck tumor cells: Results and clinical correlations , 1982, The Laryngoscope.

[44]  E. Miller,et al.  Bilateral Sixth-Nerve Palsy: A Rare Complication of Water-Soluble Contrast Myelography , 1982 .

[45]  H. Newmark,et al.  Esotropia: unusual complication of myelography and pneumoencephalography. , 1981, AJNR. American journal of neuroradiology.

[46]  T. Insel,et al.  Abducens palsy after lumbar puncture. , 1980, The New England journal of medicine.

[47]  H. Huismans.  [Neurological complication after spinal anesthesia: abducent palsy (author's transl)]. , 1979, Klinische Monatsblatter fur Augenheilkunde.

[48]  S. Seyfert,et al.  Abducens palsy after lumbar myelography with watersoluble contrast media , 1978, Journal of Neurology.

[49]  O. Liegl.  [Neuroophthalmological complications through liquor leakage after surgical operation on the spinal canal for diagnostic i.e. therapeutic purposes (author's transl)]. , 1977, Klinische Monatsblatter fur Augenheilkunde.

[50]  M. Takasaki,et al.  Case of paralysis of the abducent nerve and the trigeminal nerve after spinal anesthesia. , 1970, Geka chiryo. Surgical therapy.

[51]  R. Robles.  Cranial nerve paralysis after spinal anesthesia. , 1968, Northwest medicine.

[52]  N. M. Greene.  Neurological sequelae of spinal anesthesia. , 1961, Anesthesiology.

[53]  R. Dripps,et al.  Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). , 1956, Journal of the American Medical Association.

[54]  R. J. Kennedy,et al.  PARESIS OF THE ABDUCENS NERVE FOLLOWING SPINAL ANESTHESIA , 1952, Anesthesiology.

[55]  R. Macintosh,et al.  Sixth-nerve Palsy after Lumbar Puncture and Spinal Analgesia , 1951, British medical journal.

[56]  Ku Yc,et al.  Paralysis of extraocular muscles following spinal anesthesia; report of 2 case. , 1950 .

[57]  W. Parke.  Abducens nerve palsy following spinal anesthesia; a case report. , 1948, Anesthesiology.

[58]  S. Pritzker,et al.  Paralysis of the abducens nerve following spinal anesthesia; report of a case. , 1947, The New England journal of medicine.

[59]  H. F. Bishop,et al.  ABDUCENS NERVE PALSY FOLLOWING SPINAL ANESTHESIA , 1946, Anesthesiology.

[60]  W. Fairclough.,et al.  Sixth-nerve Paralysis after Spinal Analgesia , 1945, British medical journal.

[61]  H. J. Seddon,et al.  THREE TYPES OF NERVE INJURY , 1943 .

[62]  P. M. Wood,et al.  ABDUCEUS NERVE (VI) PARALYSIS FOLLOWING SPINAL ANESTHESIA. , 1942, Annals of surgery.

[63]  J. Biggam.  PARALYSIS OF OCULAR MUSCLES FOLLOWING SPINAL ANAESTHESIA , 1932, The British journal of ophthalmology.

[64]  J. Levine.  PARALYSIS OF AN EXTRA-OCULAR MUSCLE AFTER SPINAL ANESTHESIA , 1930 .

[65]  D. Coats,et al.  Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies. , 2002, Binocular vision & strabismus quarterly.

[66]  A. Battaglia,et al.  [Oculomotor paralysis and spinal anesthesia]. , 2001, Annales francaises d'anesthesie et de reanimation.

[67]  M. Tassignon,et al.  Combined fourth and sixth cranial nerve palsy after lumbar puncture: a rare complication. A case report. , 2001, Bulletin de la Societe belge d'ophtalmologie.

[68]  F. Vial,et al.  Paralysie oculomotrice et rachianesthésie , 2001 .

[69]  N. Martín Begué,et al.  [Paresis of the sixth nerve following spinal anesthesia]. , 2000, Revista clinica espanola.

[70]  O. Brocq,et al.  [Diplopia after peridural and intradural infiltrations of prednisolone. 2 cases]. , 1997, Presse medicale.

[71]  J. Sowka.  Neurogenic diplopia: paralysis of cranial nerves III, IV, and VI. , 1996, Optometry clinics : the official publication of the Prentice Society.

[72]  A. King,et al.  Spontaneous recovery rates for unilateral sixth nerve palsies , 1995, Eye.

[73]  H. Böhrer,et al.  [Abducens paresis after spinal anesthesia]. , 1994, Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

[74]  H. Smet,et al.  The time course of a sixth nerve paresis following epidural anesthesia. , 1994, Bulletin de la Societe belge d'ophtalmologie.

[75]  P. Martínez-Martín,et al.  [Chronic bilateral paresis of the sixth nerve following lumbar puncture]. , 1991, Neurologia.

[76]  A. Fassoulaki,et al.  Is early mobilization associated with lower incidence of postspinal headache? A controlled trial in 69 urologic patients. , 1991, Anaesthesiologie und Reanimation.

[77]  J. Ln,et al.  Cranial nerve paresis following epidural and spinal anesthesia. , 1990, Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology.

[78]  F. L. Lado Lado,et al.  [Paralysis of the 6th cranial nerve after intradural anesthesia]. , 1989, Anales de medicina interna.

[79]  A. Molins,et al.  [Bilateral paralysis of the VI cranial nerves following myelography with metrizamide]. , 1988, Neurologia.

[80]  P. Ho,et al.  Sclérose en plaques révélée par une rachianesthésie , 1988 .

[81]  J. Calhoun,et al.  Fourth cranial nerve palsy following spinal anesthesia. A case report. , 1987, Journal of clinical neuro-ophthalmology.

[82]  T. Tammela,et al.  Postoperative urinary retention. II. Micturition problems after the first catheterization. , 1986, Scandinavian journal of urology and nephrology.

[83]  M. Hummel,et al.  [Oculomotor paralysis following spinal anesthesia]. , 1986, Cahiers d'anesthesiologie.

[84]  J. L. González Machado,et al.  [Paralysis of the 6th cranial pair during intradural anesthesia]. , 1985, Revista espanola de anestesiologia y reanimacion.

[85]  E. Friedman.  Neurologic sequelae of spinal anesthesia. , 1953, New York state journal of medicine.

[86]  K. Boman.  Temporomandibular joint arthro-sis and its treatment by extirpation of the disc , 1947 .