Aseptic meningitis after spinal anaesthesia: diagnostic dilemma for anaesthetist, surgeon, and intensivist alike!

Spinal anaesthesia is a commonly performed anaesthetic procedure for inguinal, gynaecological, obstetric and lower limb surgical/orthopaedic procedures. Neurological complications after an uneventful spinal anaesthesia and surgery are infrequent and dangerous. One such complication is meningitis or meningoencephalitis, which may be infectious or non-infectious in aetiology. One subset of non-infectious meningitis is drug-induced aseptic meningitis (DIAM). DIAM may be difficult to distinguish from bacterial meningitis by clinical picture (fever, nuchal rigidity, headache, disorientation) and laboratory investigations. CSF analysis may show polymorphic picture on cytology with increased protein levels and normal to decreased glucose levels. CSF cultures are invariable negative in DIAM. Antibiotics, if started empirically, may be stopped after a diagnosis of DIAM has been made. Bupivacaine has been frequently implicated as a causative agent for post-spinal anaesthesia DIAM. The condition is self-limiting with spontaneous and complete recovery. We present a case of an ASA (American Society of Anaesthesiologists) Grade I patient posted for arthroscopic knee surgery under spinal anaesthesia. The patient developed meningeal signs in post-operative period and was admitted to ICU. DIAM seemed probable after eliminating bacterial meningitis as a probable diagnosis by negative CSF culture. The patient showed a complete recovery within a few days and was discharged uneventfully.