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Meningitis after a combined spinal epidural anesthesia: A case report

Dong Hee Woo1, Sang Ho Kim1, Sul Jang1

  • 1Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea.

Korean Journal of Anesthesiology
|January 11, 2019
PubMed

Insights

Post-dural puncture meningitis is rare. This case highlights a suspected partially treated bacterial meningitis following combined spinal epidural anesthesia, with symptoms improving after initial treatment.

Area of Science:

  • Anesthesiology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Post-dural puncture meningitis is a rare but serious complication.
  • Combined spinal epidural (CSE) anesthesia is frequently used for orthopedic procedures.
  • Early diagnosis and treatment are crucial for favorable outcomes.

Purpose of the Study:

  • To report a case of suspected partially treated bacterial meningitis after CSE anesthesia.
  • To discuss the diagnostic challenges and management of this rare complication.

Main Methods:

  • A case report of a 44-year-old patient who developed meningitis symptoms post-CSE anesthesia.
  • Cerebrospinal fluid (CSF) analysis including cell count, protein, glucose, and culture.
  • Empiric broad-spectrum antimicrobial treatment initiated.
  • Clinical monitoring and outcome assessment.

Main Results:

  • The patient presented with fever, headache, and neck stiffness post-CSE anesthesia and surgery.
  • CSF analysis showed elevated white blood cells and protein, but negative Gram stain and culture.
  • Partially treated bacterial meningitis was suspected due to pre-anesthesia antibiotics.
  • Clinical symptoms improved with continued antimicrobial therapy.

Conclusions:

  • While rare, bacterial meningitis should be considered in patients with suggestive symptoms after neuraxial anesthesia.
  • Negative CSF cultures may occur in partially treated cases.
  • Prompt empiric antibiotic treatment is essential for managing suspected meningitis.
Keywords:
Cerebrospinal fluidCombined spinal epidural anesthesiaMeningitis

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