A common way to deliver anesthesia for surgery and childbirth is to inject the a
ID: 93313 • Letter: A
Question
A common way to deliver anesthesia for surgery and childbirth is to inject the anesthesia agent into the epidural space (epidural anesthesia). A possible complication of this procedure is a tear in the dura mater that causes CSF to leak out of the central nervous system. Why would a loss of cerebrospinal fluid be problematic? What symptoms do you predict with this condition? During a procedure called a lumbar puncture, CSF surrounding the meninges is withdrawn with a needle. This procedure generally is performed between L3 and L5. Why do you think the fluid is withdrawn here rather than from higher up in the vertebral column (e.g., the cervical vertebrae)? often, the sampled CSF is tested for bacteria or viruses if a brain infection is suspected. Why would CSF sampled from the spinal cord give you information about the condition of the brain? An individual sustains injuries to only the descending tracts of the spinal cord. Will this person experience deficits movement, sensation, both, or neither? Explain.Explanation / Answer
Answer:
The covering over the spinal cord and nerves is in several layers, and the outermost layer is called the "dura mater," or simply "dura." A tear in this covering is known as a "dural tear" or a "durotomy." If this does not heal properly, this may lead to a "spinal fluid leak" or "CSF leak." This may also occur after an epidural steroid injection, spinal or spinal anesthesia, or after injection of "dye" for a CT myelogram or other procedure. Symptoms include nausea, headache, or dizziness that is relieved when lying down. Treatment for a dural tear involves lying flat for a period of bedrest to allow the tear to heal. Sometimes, injection of the patient's blood near the area of the dural tear is used to encourage healing, also known as a "blood patch." In rare cases, surgery may be required to repair the dura.
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