Abstract
Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.
Highlights
Epiduroscopy (EDS) consists of the direct visualization of the epidural space by a percutaneously inserted fiberoptic device through the sacral hiatus which allows the simultaneously diagnosis and treatment of epidural adhesions and delivering drugs [1,2,3,4,5]
Conditions in which EDS is indicated include failed back surgery syndrome (FBSS), a syndrome of intractable back and legs chronic pain which refers to a condition in which the symptoms remain unchanged or worsen after surgery
Many authors reported that adhesiolysis of the epidural space and the nerve root is effective for FBSS patients [7,8,9]
Summary
Epiduroscopy (EDS) consists of the direct visualization of the epidural space by a percutaneously inserted fiberoptic device through the sacral hiatus which allows the simultaneously diagnosis and treatment of epidural adhesions and delivering drugs [1,2,3,4,5]. Many authors reported that adhesiolysis of the epidural space and the nerve root is effective for FBSS patients [7,8,9]. The caudal approach to the epidural space can be safely reached via the sacral hiatus with the EDS especially under fluoroscopic control [5,10,11]. Complications as direct nerve root injury, dural puncture, inadvertent entry into the subarachnoid and subdural space, neck or head pain can even occur in experienced hands [5,8,9,12]. There are no reports in the literature of transient global amnesia (TGA) after epiduroscopy performed in a patient suffering of FBSS
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