///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Anesthetic Management of a Parturient with Neurocysticercosis

Abstract Number: 212
Abstract Type: Case Report/Case Series

Anne M. Drewry M.D.1 ; Rebecca D Minehart M.D.2; Lisa R Leffert M.D.3

Introduction

The parturient with central nervous system (CNS) infection presents multiple anesthetic challenges. While neuraxial techniques may be desirable, one must consider the implications of infection. CNS infections can cause raised intracranial pressure (ICP) and/or additional maternal or provider infectious risks. There is little reported on anesthetic management of parturients with neurocysticercosis.1,2 We present a case of cesarean delivery under epidural anesthesia in a woman with severe preeclampsia and neurocysticercosis.

Case Report

A 32 year old Salvadoran previously healthy female, G5P2 at 34.6 weeks estimated gestational age, with a presumptive diagnosis of neurocysticercosis, presented for urgent delivery due to severe preeclampsia. She had two prior cesarean deliveries under spinal anesthesia which were uncomplicated. At 19.9 weeks EGA, she experienced a severe headache associated with acute non-communicating hydrocephalus thought to be likely caused by congenital aqueductal stenosis. She underwent ventriculoperitoneal (VP) shunt and revision during her pregnancy. At 34.6 weeks she was found to have headache and scotoma, with a blood pressure of 170/106 mmHg and 24-hour urine protein of 800 mg/dl. Her VP shunt appeared to be working normally and she had no signs or symptoms of raised ICP. The infectious disease service concluded there were no additional infectious risks to patient and provider associated with neuraxial anesthesia. As she was not a candidate for trial of labor after cesarean delivery, she was scheduled for a repeat cesarean delivery under epidural anesthesia. Ampicillin and gentamicin were given for shunt prophylaxis. An epidural was placed at the L3-4 interspace in the usual fashion; after negative aspiration and standard test dose, a total of 20 ml of 2% lidocaine with epinephrine and bicarbonate was injected incrementally. The anesthetic was well tolerated and a healthy female infant was born without anesthetic, obstetric, or neonatal complications. Subsequently, the patients serologies confirmed cysticercosis and she was treated with a course of albendazole.

Discussion

CNS infections during pregnancy can range from mild to devastating. Neurocysticercosis is caused by CNS infection with the larval form of the tapeworm, Taenia solium. Manifestations include seizures, obstructive hydrocephalus, and increased ICP. The cerebrospinal fluid is not infective, and poses no risk to providers. There are typically no increased infectious complications from neuraxial anesthesia, specifically extracranial spread. However, one must thoroughly evaluate the extent of CNS involvement, especially regarding potential brain herniation from intentional or accidental dural puncture. In this patient with neurocysticercosis, epidural anesthesia was used safely and effectively.

References

1. Anesthesiology 2006; 105: 1056-1058.

2. Anesthesia and Analgesia 2003; 97: 580-582.

SOAP 2009