Korean J Anesthesiol.  2018 Dec;71(6):483-485. 10.4097/kja.d.17.00069.

Accidental intracerebral injection and seizure during scalp nerve blocks for awake craniotomy in a previously craniotomized patient: a case report

• Lee WK
• Kim H
• Bae MI
• Choi SH
• Min KT

• KMID: 2428081
• DOI: http://doi.org/10.4097/kja.d.17.00069

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.

Keyword

Accidental intracerebral injection; Awake craniotomy; Previous craniotomy; Scalp nerve blocks; Seizure

MeSH Terms

Adult
Anesthesia, General
Anesthetics, Local
Brain Neoplasms
Cerebral Hemorrhage
Craniotomy*
Diagnosis
Emergencies
Humans
Nerve Block*
Oligodendroglioma
Scalp*
Seizures*
Skull
Torso
Anesthetics, Local