Neurologic Complication After Intrathecal Injection Of Polygeline: A Case Report

Post dural puncture headache (PDPH) is a common complication of neuraxial anesthesia. The strategies to manage PDPH are various, including conservative methods, drugtherapy, epidural blood patch, epidural injection of colloid solution, etc. A 31-year-old woman who had undergone emergency Cesarean section due to vaginal bleeding and fetal asphyxia was analyzed. Epidural anesthesia was performed with accidental dural puncture and 20 ml polygeline was misused intrathecally in an attempt to augment cerebrospinal fluid (CSF) volume and prevent PDPH. Unfortunately, adverse complications, numbness, and paresthesia on anterior and lateral aspects of left thigh and seizures, occurred in the following days after injecting of polygeline into the subarachnoid. Epidural injection of colloid solution has been proposed to replace the blood patch for management of PDPH and the animal experiment showed its safety, with success in 31 French cases. It is believed that such solutions have negligible toxicity and side effects. However, this case reflects the neurotoxicity associated with the specific route, subarachnoid, administration polygeline, which indicate further investigations should be done in humans to evaluate the safety of this treatment.