We try to spread the word about a publication from Internal Medicine each week, though in a Department this size, many still slip past us. But when one of our residents publishes his first lead-author article, we want to make sure everyone gets a chance to offer congratulations. A case report by Dr. Sergio Sánchez-Luna, third-year resident, was just published in International Journal of Case Reports and Images, “Stroke after blood patch in a patient with postpartum angiopathy [PPA] and posterior reversible encephalopathy syndrome [PRES].” (Full text here.)
This title refers to an encounter that Dr. Sánchez-Luna had about 5 years ago when he was a visiting medical student at the University of Miami. A young woman—postpartum and complicated by eclampsia, PPA, and PRES—experienced headaches following a lumbar puncture. A common relief for these headaches is to administer an epidural blood patch, but the woman had an ischemic stroke almost immediately after. She was stabilized and, over the course of follow-up visits over the next few years, was found to have no lasting complications.
Working with his colleagues, Dr. Sánchez-Luna reviewed the existing literature for instances where epidural blood patches led to ischemic stroke and vasospasm. What they found is that although there had been documented events such as this, there were none where a patient with these particular risk factors—eclampsia, PPA, and PRES—experienced a stroke following a blood patch. “For patients with predisposing risk factors for stroke,” the case report concludes, “the vasomotor effects of an epidural blood patch may decrease a threshold for an ischemic event to occur.”
“Honestly,” Dr. Sánchez-Luna says, “(this publication) feels very exciting and rewarding to finally bring all the hard work from my co-authors and myself to fruition.” Although further neurological research into this area is not likely for Dr. Sánchez-Luna, who plans to pursue a fellowship in Gastroenterology-Hepatology after completing his residency, the experience has been important to his training. “The biggest lesson has been interdependence, since without my team’s kindness and help this could not have been achieved!”
UPDATE: Dr. Sánchez-Luna emailed later to ask that we also note that one of the co-authors, Dr. Juan Pablo Sánchez-Luna, is his brother. “It is very nice,” he wrote, “to have a ‘family publication.’ 🙂 ”