To replace or not to replace? – Partial coning and a sixth nerve palsy secondary due to displacement of a tunnelled intrathecal catheter for pain control
Thursday, July 10th, 2008.
Palliative Medicine. 2008 Jul;22(5):668-670. [Link]
Gibbins J, Steeds C, Greenslade G, Tunstall S, Patel N, Stannard C.
The Macmillan Unit, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol. janegibbins@hotmail.com.
Abstract
We report the displacement of a tunnelled intrathecal catheter causing significant cerebrospinal fluid (CSF) leak, resulting in partial coning and a sixth nerve palsy. The patient had advanced malignant mesothelioma and all other methods of pain control had been unsuccessful. As far as we are aware, there are no published reports of early replacement of an intrathecal catheter in patients with neurological sequelae. Surgical re-siting of the intrathecal catheter produced good pain relief for many months. Doctors involved in the use of indwelling intrathecal catheters for pain control must be aware of the risk of significant neurological sequelae but should not dismiss re-establishment of intrathecal therapy in the presence of significant neurological complications.
Keywords: intrathecal analgesia, cancer pain, intrathecal complications
Glossary
- therapy
- any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.
- catheter
- (cath-eh-tur) a thin, flexible tube through which fluids enter or leave the body.
- cancer
- malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
