Sinal de Lhermitte durante punção cervical lateral sumario dos acidentes possíveis na punção lateral, C1-C2 e relato de dois casos de penetração medular

Rositti, Sandro L.; Balbo, Roque J.

doi:10.1590/S0004-282X1990000300012

Resumos

O sinal de Lhermitte foi referido por dois pacientes durante punção lateral C1-C2 (PCL), devido a penetração acidental da medula espinhal. Apresentamos breve revisão da literatura sobre a lesão nervosa e/ou vascular acidental durante a PCL e fazemos recomendações técnicas para a sua prevenção.

Lhermitte's sign was referred by two patients during lateral cervical puncture (LCP) due to accidental puncture of the spinal cord; no sequelae were observed in these patients. A brief review of the literature is presented, concerning: 1. Lhermitte's sign; 2. reported accidents during LCP. Avoidance of neural and/or vascular injuries is possible by employing the posterior approach to LCP (puncture of the dorsal spinal subarachnoid space at C1-C2). The lateral suboccipital puncture (at the atlanto-occipital space) of the cisterna magna is also recommended.

Sinal de Lhermitte durante punção cervical lateral sumario dos acidentes possíveis na punção lateral, C1-C2 e relato de dois casos de penetração medular

Lhermitte's sign during lateral cervical puncture: a survey on possible accidents on lateral C1-C2 puncture with report of two cases of spinal cord puncture

Sandro L. Rositti^I; Roque J. Balbo^II

^IMédico Residente - Departamento de Neuro-Psiquiatria, Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia (MC), Hospital Vera Cruz (HVC), Campinas

^IIProfessor Adjunto da PUCCAMP e Diretor do DNC HVC -Departamento de Neuro-Psiquiatria, Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP) e Departamento de Neurocirurgia (MC), Hospital Vera Cruz (HVC), Campinas

RESUMO

O sinal de Lhermitte foi referido por dois pacientes durante punção lateral C1-C2 (PCL), devido a penetração acidental da medula espinhal. Apresentamos breve revisão da literatura sobre a lesão nervosa e/ou vascular acidental durante a PCL e fazemos recomendações técnicas para a sua prevenção.

SUMMARY

Lhermitte's sign was referred by two patients during lateral cervical puncture (LCP) due to accidental puncture of the spinal cord; no sequelae were observed in these patients. A brief review of the literature is presented, concerning: 1. Lhermitte's sign; 2. reported accidents during LCP. Avoidance of neural and/or vascular injuries is possible by employing the posterior approach to LCP (puncture of the dorsal spinal subarachnoid space at C1-C2). The lateral suboccipital puncture (at the atlanto-occipital space) of the cisterna magna is also recommended.

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Dr. Sandro L. Rossitti - Departamento de Neurocirurgia, Hospital Vera Cruz - Av. Andrade Neves 402 - 13020 Campinas SP - Brasil.

1. Baldwin RN, Chadwick D - Lhermitte's «sign» due to thoracic cord compression. J Neurol Neurosurg Psychiat 49:840, 1986.
2. Brody JA, Wilkins RH - Lhermitte's sign (Neurological Classics XXIII). Arch Neurol 21:338, 1969.
3. Fankhauser H, Kamano S, Hanamura T, Amano K, Hatanaka H - Abnormal origin of the posterior inferior cerebellar artery: case report. J Neurosurg 51:569, 1979.
4. Johansen JG, Orrison WW, Amundsen P - Lateral C puncture for cervical myelography: Part 1. Report of a complication. Radiology 146:391, 1983.
5. Kanchandani R, Howe JG - Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature. J Neurol Neurosurg Psychiat 45:308, 1982.
6. Lang J - Über extradurale Ursprünge der A. cerebelli inferior posterior (PICA) und deren klinische Bedeutung. Neurochirurgia (Stuttgart) 28:183, 1985.
7. Lang J - Craniocervical region, central nervous system and envelopes. Neuro-Orthopedics 2:1, 1986.
8. Lhermitte J, Bollak, Nicholas M - Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclerose multiple: un cas de forme sensitive de la sclerose multiple. Rev Neurol 2:56, 1924 (Vide 2).
9. Mapstone TB, Rekate HL, Shurin SB - Quadrlplegia secondary to hematoma after lateral Cl, C2 puncture in a leukemic child. Neurosurgery 12:230, 1983.
10. Margolis MT, Newton TH - The posterior inferior cerebellar artery. In Newton TH, Potts DG (eds): Radiology of the Skull and Brain. C.V. Mosby, St. Louis, 1974, Vol 2, pg 1710.
11. Mironov A - Laterale subokzipitale Punktion der Cisterna magna cerebellomedullaris. Neurochirurgia (Stuttgart) 24:150, 1981.
12. Mullan S, Harper PV, Hekmatpanah J, Torres H, Dobbin G - Percutaneous interruption of spinal-pain tracts by means of a Strontium 90 needle. J Neurosurg 20:931, 1963.
13. Orrison WW, Eldevik OP, Sackett JF - Lateral C_1-2 puncture for cervical myelography: Part 3. Historical, anatomic and technical considerations. Radiology 146:401, 1983.
14. Orrison WW, Sackett JF, Amundsen P - Lateral C_1-2 puncture for myelography: Part 2. Recognition of improper injection of contrast material. Radiology 146:394, 1983.
15. Raininko R, Sonninen P - Dorsal CSF space at C I-II level: technique of cervical myelography. Neuroradiology 29:73, 1987.
16. Rice JF, Bathia AL - Lateral C puncture: posterior approach. Radiolgy 132:760, 1979.
17. Rogers LA - Acute subdural hematoma and death following lateral cervical spine puncture: case report. J Neurosurg 58:284, 1983.
18. Rossitti SL, Araújo JFM, Zuiani AR, Balbo RJ - Dor faringea durante punção suboccipital lateral. Arq Neuro-Psiquiat (São Paulo) 47:182, 1989.
19. Servo A, Laasonen EM - Accidental introduction of contrast medium into the cervical spinal cord. Neuroradiology 27:80, 1985.
20. Sweet WH - Percutaneous cordotomy. In Schmidek HH, Sweet WH (eds): Current Techniques in Operative Neurosurgery. Grune & Stratton, New York, 1977, pg 449.
21. Wholey MH, Bruwer AJ, Baker HL Jr - The lateral roentgenogram of the neck (with comments on the atlanto-odontoid-baslon relationship). Radiology 71:350, 1958.
22. Zivin J - Lateral cervical puncture: an alternative to lumbar puncture. Neurology 28:616, 1978.

Datas de Publicação

Publicação nesta coleção
26 Maio 2011
Data do Fascículo
Set 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Baldwin RN, Chadwick D - Lhermitte's «sign» due to thoracic cord compression. J Neurol Neurosurg Psychiat 49:840, 1986.

[2] 2. Brody JA, Wilkins RH - Lhermitte's sign (Neurological Classics XXIII). Arch Neurol 21:338, 1969.

[3] 3. Fankhauser H, Kamano S, Hanamura T, Amano K, Hatanaka H - Abnormal origin of the posterior inferior cerebellar artery: case report. J Neurosurg 51:569, 1979.

[4] 4. Johansen JG, Orrison WW, Amundsen P - Lateral C puncture for cervical myelography: Part 1. Report of a complication. Radiology 146:391, 1983.

[5] 5. Kanchandani R, Howe JG - Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature. J Neurol Neurosurg Psychiat 45:308, 1982.

[6] 6. Lang J - Über extradurale Ursprünge der A. cerebelli inferior posterior (PICA) und deren klinische Bedeutung. Neurochirurgia (Stuttgart) 28:183, 1985.

[7] 7. Lang J - Craniocervical region, central nervous system and envelopes. Neuro-Orthopedics 2:1, 1986.

[8] 8. Lhermitte J, Bollak, Nicholas M - Les douleurs à type de décharge électrique consécutives à la flexion céphalique dans la sclerose multiple: un cas de forme sensitive de la sclerose multiple. Rev Neurol 2:56, 1924 (Vide 2).

[9] 9. Mapstone TB, Rekate HL, Shurin SB - Quadrlplegia secondary to hematoma after lateral Cl, C2 puncture in a leukemic child. Neurosurgery 12:230, 1983.

[10] 10. Margolis MT, Newton TH - The posterior inferior cerebellar artery. In Newton TH, Potts DG (eds): Radiology of the Skull and Brain. C.V. Mosby, St. Louis, 1974, Vol 2, pg 1710.

[11] 11. Mironov A - Laterale subokzipitale Punktion der Cisterna magna cerebellomedullaris. Neurochirurgia (Stuttgart) 24:150, 1981.

[12] 12. Mullan S, Harper PV, Hekmatpanah J, Torres H, Dobbin G - Percutaneous interruption of spinal-pain tracts by means of a Strontium 90 needle. J Neurosurg 20:931, 1963.

[13] 13. Orrison WW, Eldevik OP, Sackett JF - Lateral C_1-2 puncture for cervical myelography: Part 3. Historical, anatomic and technical considerations. Radiology 146:401, 1983.

[14] 14. Orrison WW, Sackett JF, Amundsen P - Lateral C_1-2 puncture for myelography: Part 2. Recognition of improper injection of contrast material. Radiology 146:394, 1983.

[15] 15. Raininko R, Sonninen P - Dorsal CSF space at C I-II level: technique of cervical myelography. Neuroradiology 29:73, 1987.

[16] 16. Rice JF, Bathia AL - Lateral C puncture: posterior approach. Radiolgy 132:760, 1979.

[17] 17. Rogers LA - Acute subdural hematoma and death following lateral cervical spine puncture: case report. J Neurosurg 58:284, 1983.

[18] 18. Rossitti SL, Araújo JFM, Zuiani AR, Balbo RJ - Dor faringea durante punção suboccipital lateral. Arq Neuro-Psiquiat (São Paulo) 47:182, 1989.

[19] 19. Servo A, Laasonen EM - Accidental introduction of contrast medium into the cervical spinal cord. Neuroradiology 27:80, 1985.

[20] 20. Sweet WH - Percutaneous cordotomy. In Schmidek HH, Sweet WH (eds): Current Techniques in Operative Neurosurgery. Grune & Stratton, New York, 1977, pg 449.

[21] 21. Wholey MH, Bruwer AJ, Baker HL Jr - The lateral roentgenogram of the neck (with comments on the atlanto-odontoid-baslon relationship). Radiology 71:350, 1958.

[22] 22. Zivin J - Lateral cervical puncture: an alternative to lumbar puncture. Neurology 28:616, 1978.