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Air Embolus to Arachnoid Cyst as a Rare Delayed Complication of Intrathecal Medication Delivery A Case Report

Air Embolus to Arachnoid Cyst as a Rare Delayed Complication of Intrathecal Medication Delivery A Case Report. Daniela Atencio, B.S.* John Gachiani, M.D.* Erich O. Richter, MD.*. *Department of Neurosurgery, LSU Health Sciences Center, New Orleans, LA. Introduction.

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Air Embolus to Arachnoid Cyst as a Rare Delayed Complication of Intrathecal Medication Delivery A Case Report

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  1. Air Embolus to ArachnoidCyst as a Rare Delayed Complication of Intrathecal Medication DeliveryA Case Report Daniela Atencio, B.S.* John Gachiani, M.D.* Erich O. Richter, MD.* *Department of Neurosurgery, LSU Health Sciences Center, New Orleans, LA

  2. Introduction • IT therapy is a common treatment for intractable chronic pain. • Several complications have been described from long term use of IT medication, especially IT opioids.

  3. “Assessing Syndromes of Catheter Malfunction With SynchroMed Infusion Systems: The Value of Spiral Computed Tomography With Contrast Injection” Turner, Michael S. PMR Journal. 2010.

  4. Patient History • 56 year-old woman with history of chronic back pain following trauma. • Intrathecal morphine delivery device implanted in 2000.

  5. Patient History Several years later she presented with symptoms of loss of drug effect. Catheter revision, repositioning the Catheter tip at a T9-T10 level. Following epidural injection and myelogram, she presented with acute, severe neurologic decline.

  6. Neurological Examination Right Side Muscle Strength Left Side Muscle Strength Reflexes: Upper Extremities= 1 Lower Extremities= Absent. *Incomplete sensory loss with a thoracic level

  7. Discussion • The arachnoid cyst was near the previous catheter tip position (prior to revision), we inferred that the cyst was an undiagnosed CSF loculation from the time of the previous revision. • Pneumorrhachis, air trapped within the spinal canal is a rare condition that is usually asymptomatic. [2, 3] • In this case the air was constrained by arachnoid adhesions and appears to have exerted a mass effect with severe neurological deficits . • Although CSF loculation has been described as a complication of long term use of IT medication, severe compressive complications from such loculations has not been previously reported.

  8. References • Bagnall, David. The Use of Spinal Cord Stimulation and Intrathecal Drug Delivery in the Treatment of Low Back-Related Pain. Phys Med Rehabil Clin N Am. Vol 21, issue 4. Nov 2010, 851-858. • Chaicana Kaisorn L., Pradilla Gustavo, Witham Timothy F., Gokaslan Ziya L., Bydon Ali. The Clinical Significance of Pneumorachis: A Case Report and Review of Literature. The Journal of Trauma Injury, infection and Critical Care. Vol 68, Number 3, March 2010. • Oertel, Markus F., Korinth, Marcus C., Reinges, Marcus H.T., Krings, Timo., Terbeck, Sandra., Gilsbach, Joachim M. Pathogenesis, Diagnosis and Management of Pneumorrhachis. Eur Spine J. 2006. 15. (Suppl. 5):S636-S646. • Phillips, Jinnah A., Escott, Edward J., Moossy, John J., Kellermier, Harry C. Imaging Appearance of Intrathecal Catheter Tip Granulomas: Report of Three Cases and Review of the Literature. Am. J. Roentgenol. 2007 189: W375-381 • Turner, Michael S. Assessing Syndromes of Catheter Malfunction With SynchroMed Infusion Systems: The Value of Spiral Computed Tomography With Contrast Injection. PMR Journal; 2010. Vol. 2, Issue 8 , 757-766.

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