Brainstem anesthesia presenting as dysarthria

After having a retrobulbar injection for anesthesia before cataract surgery, a patient developed dysarthria. This was the presenting sign for penetration of the optic nerve sheath by the retrobulbar injection, with subsequent brainstem anesthesia. Thereafter, the patient demonstrated cranial nerve dysfunctions with tongue deviation, tachycardia, hypertension, and contralateral sixth and third nerve palsies. I believe this is the first documented case in which dysarthria is the presenting sign for brainstem anesthesia resulting from a retrobulbar injection.