Document Detail

Dural Puncture-Induced Intracranial Hypotension Causing Diplopia.
MedLine Citation:
PMID:  23343786     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Diplopia that occurs after an epidural spinal catheter has been placed for pain control has been attributed to sixth nerve palsy nerve palsy induced by intracranial hypotension. There is sparse information about the factors that confound diagnosis in this setting. METHODS:: Review of 6 cases examined over a period of 5 years at a single tertiary care medical center. RESULTS:: Six confounders to diagnosis were identified: 1) lack of awareness that an epidural spinal catheter was or had been in place; 2) delayed reporting of diplopia; 3) mild or inapparent ductional deficits; 4) lack of postural headache; 5) clinical features that suggested an alternative diagnosis; 6) neuroimaging features that did not allow exclusion of pachymeningitis. CONCLUSION:: Clinicians should be aware of features that confound a diagnosis of dural puncture-induced intracranial hypotension as a cause of diplopia in the post-operative period when an epidural pain control system is or has been deployed. If these confounders are recognized and the correct diagnosis is reached, radiologists will be less likely to diagnose pachymeningitis and clinicians will be able to avoid lumbar puncture, which may exacerbate the condition.
Padmaja Sudhakar; Jonathan D Trobe; Jeffrey Wesolowski
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-22
Journal Detail:
Title:  Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society     Volume:  -     ISSN:  1536-5166     ISO Abbreviation:  J Neuroophthalmol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431308     Medline TA:  J Neuroophthalmol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Departments of Ophthalmology and Visual Science (PS, JDT), Neurology (JDT), and Radiology (Neuroradiology) (JW), University of Michigan, Ann Arbor, Michigan.
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