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.
ABSTRACT
Hoehn and Yahr (H-Y) staging and the Unified Parkinson's Disease Rating Scale (UPDRS) are commonly used for clinical evaluation of Parkinson's disease (PD). Iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and single photon emission computed tomography (SPECT) are useful for the differential diagnosis of PD from other Parkinsonism. Additionally, gravicorders or gait analysis systems and upper limb voluntary movement analyzing systems may be helpful for the quantitative evaluation of parkinsonian symptoms. From the early stage of H-Y, PD patents should be informed and coached about rehabilitation programs by expert therapists. Educational and health promotional gymnastics are the main programs used in stage I and II. Muscle stretching exercises, postural exercises, balance training and activity/instrumental-activity training are needed in stage III and IV. Finally, preventing changes due to disuse and lightening the caregiver load are the main purpose of rehabilitation in stage V. It is very important to understand not only the patients' clinical stages but also their personal situations such as their life-stage and life-style and their family situation. Home visit rehabilitation is useful to discover the actual daily living problems faced by patients and their families. Then, evaluation according to the International Classification of Functioning, Disability and Health (ICF) is available to clarify and solve the problems. With the progression of the clinical stage, patients need many social resources. Therefore, medical social workers (MSW) should be a part of the rehabilitation team to support the home care of patients from their incipient stage.