RESUMO
We report 4 cases of ischemic brain and spinal cord injury after shoulder surgery in the beach chair position, using data from medical legal case reviews. We argue that the correlation between cardiovascular risk factors and cerebral ischemic complications for this type of surgery is poor in these middle-aged patients. Rather, our analysis suggests that the sitting position and the head position create specific physiological conditions that may be conducive to cerebral and spinal cord ischemia during this type of surgery. Thromboembolic events may be an additional cause of adverse neurologic outcomes.
Assuntos
Isquemia Encefálica/etiologia , Complicações Intraoperatórias/fisiopatologia , Ombro/cirurgia , Adulto , Artroplastia de Substituição , Artroscopia , Morte Encefálica , Isquemia Encefálica/patologia , Isquemia Encefálica/fisiopatologia , Infarto Cerebral/etiologia , Infarto Cerebral/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Postura , Fatores de Risco , Manguito Rotador/cirurgia , Articulação do Ombro , Traumatismos da Medula Espinal/etiologiaRESUMO
Spinal epidural hematoma in the absence of coagulopathy or anticoagulation therapy is an extremely rare occurrence, with a reported incidence of less than 1 in 1 million. We present seven cases of documented epidural hematoma in the absence of coagulopathy or anticoagulation therapy to alert the clinician to consider spinal or epidural hematoma when suspicious signs and symptoms are present after neuraxial block in the absence of coagulopathy or anticoagulation therapy. The need for immediate diagnosis and therapy is emphasized as the only potential for meaningful recovery.