A&A practice
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Case Reports
Anesthetic Management of a Child With Rapid-Onset Dystonia-Parkinsonism (DYT12-ATP1A3): A Case Report.
Rapid-onset dystonia-parkinsonism also known as DYT12-ATP1A3 is an extremely rare neurological disease. Patients develop dystonia, bradykinesia, postural instability, dysarthria, and dysphagia. ⋯ We report the case of a 14-year-old patient diagnosed with rapid-onset dystonia-parkinsonism who was scheduled for injection of botulinum toxin in his upper limbs under general anesthesia. To our knowledge, there is no previous report about the anesthetic management of patients with rapid-onset dystonia-parkinsonism.
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Obstructive hydrocephalus caused by brainstem compression is a life-threatening complication and usually occurs within 6 days, with peak on day 3 after onset of cerebellar infarction. We present a case of obstructive hydrocephalus that developed on day 8 in a patient with cerebellar infarction. ⋯ He was lucid postoperatively, but his consciousness was diminished on day 8 because of obstructive hydrocephalus. Cerebral edema due to cardiopulmonary bypass may contribute to delayed onset of obstructive hydrocephalus, especially in patients with large-sized cerebellar infarction.
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The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. ⋯ The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.
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We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion. The obstetric anesthetic implications for patients with HOKPP and how this disorder impacts the evaluation of acute motor weakness in the immediate postpartum period in a patient who recently received a neuraxial procedure are discussed.
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The sacroiliac joint (SIJ) is a common source of pain in patients with low back pain. Untreated pain from the SIJ can lead to prolonged discomfort and financial burden. ⋯ However, there is no clear description of SIJ cryoneurolysis in the published literature. In this report, we present 5 patients with SIJ-related pain and we describe the ultrasound-guided SIJ cryoneurolysis technique and its analgesic efficacy.