Chemical Meningitis after Spinal or Epidural Anesthesia

Abstract

Background: Chemical meningitis results from foreign materials causing inflammation to the meninges covering the brain and spinal cord. Cerebrospinal fluid (CSF) study of chemical meningitis mimics bacterial meningitis. Case Report: We report three cases of chemical meningitis after spinal or epidural anesthesia with mepivacaine or bupivacaine. They experienced mental change or seizure. The results of CSF study revealed increased polymorphonuclear cell count and protein level and decreased glucose concentration. Gram staining and bacterial culture of CSF were all negative. We started empirical antibiotics and corticosteroids immediately and the patients were rapidly improved. Concclusion: The chemical meningitis should be differentiated in bacterial meningitis because bacterial meningitis is life-threatening and requires immediate antibiotic therapy. Chemical meningitis dramatically responds to steroid. The results of CSF study improved shortly after steroid administration.

Keywords

• Chemical meningitis
• Epidural anesthesia
• Spinal