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KMID : 1201420140070020122
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Journal of Neurocritical Care
2014 Volume.7 No. 2 p.122 ~ p.124
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A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection
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Kim Ji-In
Lee Seong-Soo
Choi Jin-Kyo
Lee Jin-Woo
Lee Ji-Yong
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Abstract
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Background: Iatrogenic meningitis after spinal anesthesia is a rare condition. Most cases of iatrogenic meningitis have a bacterial etiology; however, there are a few reports of chemical meningitis associated with intrathecal administration of bupivacaine.
Case Report: A 74-year-old man underwent cystoscopy, with anesthesia by intrathecal bupivacaine hydrochloride injection. Two hours post-procedurally, he complained of a severe headache and his mental status subsequently deteriorated from alertness to confusion. Cerebrospinal fluid examination on the day of admission showed an increase in cell count (841/mm3; polymorphonuclear 78%: mononuclear 10%) and total protein (460 mg/dL). His clinical findings and laboratory abnormalities were consistent with the diagnosis of bupivacaine-induced chemical meningitis, rather than the bacterial meningitis.
Conclusion: We report a case of chemical meningitis after spinal anesthesia with bupivacaine. Differential diagnosis should include chemical meningitis in cases of meningitis after spinal anesthesia.
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KEYWORD
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Meningitis, Spinal anesthesia, Bupivacaine
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