Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
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Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient -a case report-

  • Lee, Woo Kyung (Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Kim, Hyunzu (Department of Anesthesiology and Pain Medicine, Inha University College of Medicine) ;
  • Bae, Myung-Il (Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Choi, Seung Ho (Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine) ;
  • Min, Kyeong Tae (Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine)
  • Received : 2017.11.20
  • Accepted : 2018.01.03
  • Published : 2018.12.01
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Abstract

A 34-year-old man who previously underwent a craniotomy due to oligodendroglioma was admitted with a diagnosis of recurrent brain tumor. An awake craniotomy was planned. Approximately 15 minutes after completing the scalp nerve block, his upper torso suddenly moved and trembled for 10 seconds, suggesting a generalized clonic seizure. He recovered gradually and fully in 55 minutes without any neurological sequelae. The emergency computed tomography scan revealed a localized fluid collection and small intracerebral hemorrhage nearby in the temporoparietal cortex beneath the skull defect. He underwent surgery under general anesthesia at 8 hours after the seizure and was discharged from the hospital after 10 days. This report documents the first case of generalized seizure that was caused by the accidental intracerebral injection of local anesthetics. Although the patient recovered completely, the clinical implications regarding the scalp infiltration technique in a patient with skull defects are discussed.

Keywords

References

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