There have been no case reports of cranial nerve paralysis from total spinal anesthesia. This case report is to explain the possibility of cranial nerve involvement from high spinal anesthesia. A 17-year-old girl with a huge abdominal mass underwent exploratory laparotomy under spinal anesthesia. A lumbar tapping was performed in a sitting position at a level between L4-L5 using a 22 gauze pencil point needle, then 4 cc of 0.4% tetracaine in 6% D/W was injected into the subarachnoid space, followed by the patient lying down in a slight Trendelenburgs position. Shortly after the spinal injection of pontocaine, all signs of a high spinal block could be observed clearly, accompanided by the following increasing signs of intracranial nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve, trigeminal nerve, trochreal nerve and finally oculomotor nerve in that order. She was then intubated and her respiration was controlled without delay. The patient recovered gradually in the reverse order one hour from the time after the spinal injection of pontocaine, without any permanent damage noted. Differential diagnosis between the shock and pure total spinal anesthesia are described here in.
Adolescent ; Anesthesia, Spinal* ; Cranial Nerves* ; Deception ; Diagnosis, Differential ; Female ; Glossopharyngeal Nerve ; Humans ; Injections, Spinal ; Laparotomy ; Needles ; Oculomotor Nerve ; Paralysis* ; Phrenic Nerve ; Respiration ; Shock ; Subarachnoid Space ; Tetracaine ; Trigeminal Nerve ; Vagus Nerve