CT Cisternography

Today we did a case of CT Cisternography.

45 year female with history of Nasal leaking which was being evaluated for CSF rhinorrhoea. She had history of allergy to NSAIDs. After ingestion of Indomethacin last month for back ache, she had developed rashes over her body. She also had some rashes on her face unrelated to the drug ingestion, workup of which was done by dermatologists to rule out SLE. (ANA and dsDNA negative). Provisional diagnosis of seborrhic dermatitis /photodermatitis was made.

In her pre anaesthesia evaluation she was found to have BP recordings on the higher side on 3 ocassions and was started on Tab. Amlodepin 5 mg once a day in the mornings.

Her vitals were stable prior to the procedure and was given IV Pheniramine maleate 22.75 mg and IV Hydrocortisone 100 mg prophylactically.

Under all aseptic precautions, lumbar puncture was done by the midline approach in L3L4 interspace with patient sitting in single try. After confirming clear and free CSF flow 3 cc of iohexol dye (Non Ionic contrast) with 3 cc sterile NS was injected in the subarachnoid space at 12.05 am. Soon after the injection patient complained of pain in the right lower limb which was sharp, shooting and bearable. After giving a head low dor 2o mins, CT scan was done. Another series of films were shot after a wait of 30 mins. The patient's pain had increased in the meanwhile and by 1.45 pm she was in severe unbearable pain which had not reduced after giving IV Paracetamol 600 mg.

She was admitted and immediately shifted to the PACU. She was give IV Tramadol100 mg with IV Metoclopramide 10mg to which her pain responded but only slightly.

Neuromedicine reference was made and a provisional diagnosis of "Post Cisternography Radiculopathy" was made and she is now on Tab. Gabapentin 600mg. Her pain has now subsided and she is comfortable.

More details, if any I shall update by Sunday.