Seizures After Ureteral Stone Manipulation With Lidocaine

Abstract

A 40-year-old 62 kg. woman with no medical history, no known drug allergies and no prior exposure to lidocaine presented with acute onset of colicky left flank pain. Excretory urography showed a 3 mm. stone at the left ureteropelvic junction with moderate hydronephrosis. After failing to pass the stone and remaining symptomatic, she was hospitalized for extracorporeal shock wave lithotripsy with the stone now in the lower ureter. After induction of intravenous sedation, an 8F open ended catheter was passed over a 0.38 guide wire following several unsuccessful attempts due to resistance met in the distal ureter. Then, 20 ml. 2% lidocaine hydrochloride jelly (400 mg.) diluted to half strength with saline were injected with manipulation of the stone to the sacroiliac joint. Because of inability to pass a 10F catheter an 8F manipulator catheter was passed and 20 ml. 2% lidocaine were injected with manipulation of the stone to the L5 vertebrae. Within several minutes of the second injection the patient experienced 3 to 4 episodes of generalized tonic-clonic seizures each lasting 30 to 40 seconds, which stopped after treatment with thiopental. The procedure was terminated after placement of a DoubleJ* stent. Evaluation by a neurologist, including computerized tomography of the head, was negative. She underwent ureteroscopic stone extraction 5 days later without complication, and remained stone-free and without neurological sequela 1 year later. DISCUSSION