RESUMEN
We present a case of a patient who received nitrous oxide on two occasions within a period of 8 weeks and who subsequently developed a diffuse myelopathy, characterized by upper extremity paresis, lower extremity paraplegia and neurogenic bladder. Laboratory testing revealed hyperhomocysteinaemia and low levels of vitamin B(12). Because of this uncommon clinical presentation, we analysed the patient's DNA, and found a polymorphism in the MTHFR gene that is associated with the thermolabile isoform of the 5,10-methylenetetrahydrofolate reductase enzyme, which explained the myelopathy experienced by the patient after being exposed to nitrous oxide. Soon after initiating supplementary therapy with folic acid and vitamin B(12), the neurological symptoms subsided.
Asunto(s)
Anestésicos por Inhalación/efectos adversos , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Óxido Nitroso/efectos adversos , Polimorfismo Genético , Enfermedades de la Médula Espinal/inducido químicamente , Ácido Fólico/uso terapéutico , Predisposición Genética a la Enfermedad , Humanos , Hiperhomocisteinemia/complicaciones , Masculino , Persona de Mediana Edad , Parálisis/inducido químicamente , Complicaciones Posoperatorias , Enfermedades de la Médula Espinal/tratamiento farmacológico , Enfermedades de la Médula Espinal/genética , Vitamina B 12/uso terapéuticoRESUMEN
We report two cases of Caesarean section in patients with Marfan's syndrome where continuous subarachnoid anaesthesia failed to provide an adequate surgical block. This was possibly because of dural ectasia, which was confirmed by a computed tomography scan in both cases.