naa a22 4500 510744370 CHVBK 20180411083040.0 cr unu---uuuuu 180411e20130501xx s 000 0 eng 10.1007/s12630-013-9904-z doi (NATIONALLICENCE)springer-10.1007/s12630-013-9904-z Epidural blood patch in a patient with multiple sclerosis: is it safe? [Elektronische Daten] [Vesselina Koeva, Amit Bar-Or, Daniel Gendron, Steven Backman] Le colmatage sanguin péridural chez une patiente atteinte de sclérose en plaques: est-ce sécuritaire? Purpose: Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system resulting in demyelination and axonal injury. Epidural blood patch (EBP) to treat postdural puncture headache (PDPH) in an MS patient may be of concern because of the potential for this to interfere with axonal conduction. Even with normal axons, pressure can interfere with impulse conduction, and it is unknown whether affected axons of the MS patient are particularly vulnerable to the increase in epidural pressure that occurs as a consequence of the EBP. We describe our experience with EBP in an MS patient. While peridural pressure changes were not measured, we attempted to quantify any pressure-induced interference with axonal conduction by measuring changes in somatosensory evoked responses. Clinical features: A 50-yr-old female MS patient required an EBP for a PDPH after a diagnostic lumbar puncture. The first EBP (20mL autologous blood, L3-4 interspace) was followed by a transient improvement in PDPH and then a worsening with increased lower-extremity weakness. A second EBP was performed (12mL autologous blood, L3-L4 interspace) with concomitant evoked potential recordings (stimulating electrodes over the left posterior tibial nerve and recording electrodes at CZ-FZ coordinates). Postdural puncture headache symptoms were permanently relieved, and the effects of the EBP on evoked P40 latency responses (39.7msec and 44.3msec pre- and post-EBP, respectively) were considered to be physiologically insignificant. Conclusion: A report of EBP to treat PDPH in an MS patient is presented. We postulate that this type of patient may be at risk for impaired conduction of impulses in affected axons due to the increase in pressure produced by epidural injection of blood. Literature review indicates that pressure increases may be reduced by injecting the blood slowly. When EBP is considered in patients with axon conduction deficits, consideration should be given to concomitant monitoring of somatosensory evoked responses to help quantify interference with axonal conduction as a consequence of injection of blood into the epidural space. Canadian Anesthesiologists' Society, 2013 Koeva Vesselina Department of Anesthesia, McGill University, Montreal, QC, Canada aut Bar-Or Amit Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada aut Gendron Daniel Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada aut Backman Steven McGill University, Royal Victoria Hospital, F9.08, 687 Pine Ave. W., H3A 1A1, Montreal, QC, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/5(2013-05-01), 479-483 0832-610X 60:5<479 2013 60 12630 https://doi.org/10.1007/s12630-013-9904-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9904-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Koeva Vesselina Department of Anesthesia, McGill University, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Bar-Or Amit Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Gendron Daniel Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Backman Steven McGill University, Royal Victoria Hospital, F9.08, 687 Pine Ave. W., H3A 1A1, Montreal, QC, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/5(2013-05-01), 479-483 0832-610X 60:5<479 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer