ABSTRACT
Herein, we report a case of a 49-year-old man with a history of bilateral hemiplegia caused by severe traumatic brain injury. During his stay in the convalescent rehabilitation hospital, he developed a flexion deformity of the 4th and 5th fingers of his right hand. Elbow palpation and ultrasonography showed that the ulnar nerve was dislocated from the elbow canal, and a nerve conduction study revealed that the conduction velocity was low in the right elbow. Thus, a diagnosis of cubital tunnel syndrome was made and an ulnar nerve transfer was performed to prevent progression. Prior to onset, an over-table had been used by the patient for daily activities such as sitting, training, and eating. Therefore, it was considered that the repeated use of the over-table plausibly exerted pressure on the dislocated ulnar nerve, leading to the onset of the cubital tunnel syndrome.As over-tables and wheelchair armrests are often used during rehabilitation, it is imperative to pay attention to elbow compression when using them in patients with ulnar nerve dislocation.
ABSTRACT
Herein, we report a case of a 49-year-old man with a history of bilateral hemiplegia caused by severe traumatic brain injury. During his stay in the convalescent rehabilitation hospital, he developed a flexion deformity of the 4th and 5th fingers of his right hand. Elbow palpation and ultrasonography showed that the ulnar nerve was dislocated from the elbow canal, and a nerve conduction study revealed that the conduction velocity was low in the right elbow. Thus, a diagnosis of cubital tunnel syndrome was made and an ulnar nerve transfer was performed to prevent progression. Prior to onset, an over-table had been used by the patient for daily activities such as sitting, training, and eating. Therefore, it was considered that the repeated use of the over-table plausibly exerted pressure on the dislocated ulnar nerve, leading to the onset of the cubital tunnel syndrome.As over-tables and wheelchair armrests are often used during rehabilitation, it is imperative to pay attention to elbow compression when using them in patients with ulnar nerve dislocation.
ABSTRACT
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis；however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities；however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch；however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.
ABSTRACT
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis；however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities；however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch；however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.