RESUMO
A man in his late 60s had vertigo and vision tilt following a dental procedure. A cerebellar haemorrhage and cerebral microbleeds (CMBs) were diagnosed on imaging. Subsequent testing revealed CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The role of the dental procedure as a trigger for intracerebral haemorrhage (ICH) is discussed. The incidence of CMBs and ICH in CADASIL is discussed. A summary of the causes and pathology associated with visual tilt is documented.
Assuntos
CADASIL , Masculino , Humanos , CADASIL/complicações , CADASIL/diagnóstico , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/complicações , Infarto Cerebral/complicações , Incidência , Odontologia , Imageamento por Ressonância MagnéticaRESUMO
A thoracic paravertebral block (TPVB) can provide anesthesia for breast cancer surgeries. This case report describes a 58-year-old woman with a prolonged ipsilateral dense C5 dermatomal sensory and motor blockade after receiving a TPVB at T4 with 40 mL of 0.2% ropivacaine for a left total mastectomy, suggesting a high cephalad spread of anesthesia up to C5 paravertebral spaces. The lower extremities and the diaphragm were not involved. It is possible that the large volume of local anesthetic, even at low concentration, combined with her previous neural pathology and surgical laminectomy resulted in unexpected postoperative neurological changes.