A 6 year-old girl presented with a midline parietal scalp swelling that had been gradually enlarging since birth. Magnetic resonance imaging revealed communication of the cyst with the subarachnoid space through a calvarial defect, with concomitant findings of vertically positioned straight venous sinus and subependymal grey matter heterotopia. A diagnosis of atretic cephalocele was thus made based on these classical imaging findings.
A local anaesthetic agent with adrenalin meant for infiltration block was inadvertently given into spinal canal without any serious sequelae. The consequences of adrenalin in the subarachnoid space are discussed. Measures to prevent such accidents are suggested.
Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section.