Central sensory-motor deficit after uneventful single-dose spinal morphine administration in a patient with preexisting migraine headaches.

Lentschener C; B. Dousset; Zuber M; Ozier Y

doi:10.1213/ane.0b013e3181b7c60f

Central sensory-motor deficit after uneventful single-dose spinal morphine administration in a patient with preexisting migraine headaches.

Lentschener C, B. Dousset, Zuber M, Ozier Y

Anesthesia and analgesia · 2009 · doi:10.1213/ane.0b013e3181b7c60f · PMID:19843810

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A patient with hemiplegic migraine developed persistent central sensory-motor deficits, including left-sided weakness and saddle anesthesia, following single-dose spinal morphine administration.

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This case report describes a patient who developed persistent central neurological deficits following the administration of a single dose of spinal morphine during an uneventful procedure. Although the patient had no prior history of neurological conditions, she exhibited left-sided quadriceps weakness, saddle anesthesia, and urinary retention that remained present three years post-surgery. The authors hypothesize that these lasting symptoms resulted from an interaction between spinal morphine and underlying vascular dysfunction associated with hemiplegic migraine, which manifested as recurrent transient hemiplegia in subsequent years. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Hemiplegic migraine is a condition associated with vascular alteration of the central nervous system and transient neurologic deficits. Permanent morphine-induced motor dysfunction has been reported after spinal ischemia. We report a persisting central neurological deficit after single-dose spinal administration of 400 microg of morphine in a patient with no previous neurological condition. Hemiplegic migraine was thought to be present when the patient emerged from anesthesia. Weakness in the left quadriceps and saddle anesthesia of the perineum and urinary retention of central origin remained present 3 yr later. Over the 3 postoperative years, the patient was admitted to a neurological unit 5 times because of acute headache associated with complete left-sided hemiplegia. These symptoms resolved within 24 h of onset. Hemiplegic migraine was thought to be the most likely diagnosis of these recurrent attacks. We hypothesize that the patient's persistent deficits were caused by a combination of spinal morphine and spinal cord vascular dysfunction associated with hemiplegic migraine.

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Central Sensory-Motor Deficit After Uneventful Single-Dose Spinal Morphine Administration in a Patient with Preexisting Migraine Headaches - Claude Lentschener - Bertrand Dousset - Mathieu Zuber - Yves Ozier Hemiplegic migraine is a condition associated with vascular alteration of the central nervous system and transient neurologic deficits. Permanent morphine-induced motor dysfunction has been reported after spinal ischemia. We report a persisting central neurological deficit after single-dose spinal administration of 400 μg of morphine in a patient with no previous neurological condition. Hemiplegic migraine was thought to be present when the patient emerged from anesthesia. Weakness in the left quadriceps and saddle anesthesia of the perineum and urinary retention of central origin remained present 3 yr later. Over the 3 postoperative years, the patient was admitted to a neurological unit 5 times because of acute headache associated with complete left-sided hemiplegia. These symptoms resolved within 24 h of onset. Hemiplegic migraine was thought to be the most likely diagnosis of these recurrent attacks. We hypothesize that the patient’s persistent deficits were caused by a combination of spinal morphine and spinal cord vascular dysfunction associated with hemiplegic migraine.

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