P042: STROKE ALERT AFTER INADVERTENT PLACEMENT OF THORACIC SUBDURAL CATHETER
Robert Stoker; University of Florida
Introduction: A 34 year old female with PMH of Myasthenia Gravis and upper extremity DVT secondary to CVL placement presented to the CICU s/p Robotic Thymecomy, right sided approach. Preoperatively, the patient had a T4 epidural placed for post-op pain control. Shortly after arrival to CICU, she described right arm numbness and weakness followed by right sided Horner’s Symptoms and right lower limb numbness and weakness.
Work Up: With new onset of symptoms as described above, a Stoke Alert was called which resulted in the Neurology service performing a thorough assessment. Before the Neurology service had arrived, the patient’s epidural catheter was turned off, but left in place. After obtaining history and performing a physical exam, the patient was taken for a STAT CT Head. Results of the scan were without obvious signs of acute stroke.
Clinical Course: By the time the patient returned from the CT scanner, her symptoms had begun to resolve, but her pain had increased drastically. Her epidural pump was restarted. Within 30 min, the patient’s symptoms as described above returned and the catheter was again turned off permanently. An epidurogram was performed to visualize the tip of the catheter and spread of the injectate. The results showed both epidural and subdural location of the contrast which had spread from the lower cervical nerve roots to the lumbar nerve roots in an disorganized spread – more on the right than the left. The catheter was declared to be subdural and was immediately removed. The symptoms never returned.
Discussion/Conclusions: For patients experiencing new onset numbness or weakness for after placement of an epidural catheter, the provider’s differential should include inadvertent placement of catheter in the subdural space.