Resurgence of diphtheria: clinical profile and outcome in a tertiary care hospital of South India

Background: Diphtheria is a potentially fatal acute disease caused by Corynebacterium diphtheria. It was one of the leading causes of mortality in the pre vaccination era. This study is an attempt to highlight the clinical profile, outcome and demographic characteristics, immunization status of pediatric diphtheria cases in South India. Objective of the study was to analyze the clinical profile, immunization status and outcome in children with diphtheria admitted to the PICU in a tertiary care hospital.Methods: This retrospective study was conducted in a tertiary care hospital in South India. The case records of all children admitted to the hospital between January 1st, 2014 to December 31st, 2018 with clinically suspected diphtheria were analyzed. The data was analyzed with respect to clinical features, demographic characteristics, immunization status, complications and outcome using appropriate statistical methods.Results: 18 cases were clinically suspected to have diphtheria. The average age of children presenting with diphtheria was 9 years. Out of the 18 cases, 11 were male, 7 were female. 16 out of 18 cases were from rural areas, whereas only 2 cases were from urban areas. Fever, sore throat and dysphagia were the presenting complaints in all cases. Neck swelling, white patch over tonsil and tender cervical lymphadenopathy were the other findings noted. Out of 18 cases, 7 were completely immunized, 8 were incompletely immunized and 3 were not immunized. Antidiphtheritic serum was given in 14 cases. Myocarditis, airway compromise and neurological deficits were the complications noted. Case fatality rate was 50%.Conclusions: Diphtheria still remains a major public health problem in developing countries like India. Mortality and morbidity due to diphtheria continues to be high despite ready availability of vaccines and antitoxin. Childhood immunization program, especially follow up and administration of booster doses must be prioritized.

Management Of Paraparesis Developed After Spinal Tuberculosis Through Ayurveda- A Case Study

Spinal tuberculosis is one of the most dangerous and destructive form of tuberculosis. Predisposing factors for spinal TB are same as that of pulmonary TB, which include poverty, overcrowding, illiteracy, malnutrition, diabetes mellitus, HIV infection, alcoholism, drug abuse. Though TB of cervical spine is rare but neurological deficits are more common as compared to lumbar spine. This is a case of 9 year old male child who developed neurological deficits after TB cervical spine. Panchakarma therapy along with oral medicines given for duration of one year provided significant relief in symptoms as- generalized weakness, muscle rigidity, muscle weakness. Further continuation of treatment is expected to bring more benefit.

The expression of C1q/TNF-related protein-1 in patients with acute ischemic stroke and its predictive value for the severity of neurological deficits / 实用医学杂志

Objective To investigate the expression of C1q/TNF-related protein-1(CTRP1)in patients with acute ischemic stroke and its predictive value for the severity of neurological deficits. Methods A total of 452 patients with newly diagnosed ischemic stroke(IS)from February 2014 to February 2017 in our hospital were selected as the study subjects,and 403 healthy subjects were selected as control group in the physical examination center. The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological status of pa-tients at admission and at 6 months after discharge. The expression of CTRP1 in plasma was detected by enzyme-linked immunosorbent assay(ELISA). Multiple linear regression was used to analyze the relationship between neu-rological deficit and CTRP1. Results The expression level the CTRP1in the healthy control group[(119.53 ± 17.62)ng/mL],unexplained causes IS[(145.81 ± 18.96)ng/mL],large atherosclerotic IS[(153.17 ± 19.21) ng/mL],cardiac IS[(156.56 ± 20.96)ng/mL]and small artery occlusion IS[(169.23 ± 22.34)ng/mL]in-creased gradually with statistically significant difference(P < 0.05). The level of CTRP1in the healthy control group[(119.53 ± 17.62)ng/mL],mild neurologic impairment group[(156.29 ± 19.86)ng/mL],moderate neuro-logic impairment group[(168.74 ± 18.53)ng/mL]and severe neurologic impairment group[(175.96 ± 19.15)ng/mL]increased gradually with statistically significant difference (P < 0.05). Multiple linear regression analysis showed that CTRP1,age,diabetes,Hs-CRP and LDL-C were independent factors of neurological deficits at 6 months after discharge in IS patients. Conclusion CTRP1 can effectively predict the severity of neurological defi-cits in patients with acute IS.

A child with neurological deficits, electrolyte imbalance, and arrhythmia.

A child presented with an acute febrile illness associated with neurological symptoms. The differential diagnoses of such a presentation with effects of prolonged hospitalization is discussed.

Mechanism of blood-brain barrier impairment after mild traumatic brain injury caused by blast shock waves and its relationship with delayed nerve dysfunction / 解放军医学杂志

Mild traumatic brain injury (mTBI) caused by blast shock waves (BSWs) is one of the most common injuries among soldiers in the war. Such mTBI can also happen in civilians if exposed to shock waves of accidental explosion disasters, bomb attacks by terrorists and so on. This injury often results in cognitive problems, memory dysfunction and emotional disorder, and these neurological deficits are closely related to the dysfunction or disruption of the blood-brain barrier (BBB). The present paper discusses mainly the relationship between dysfunction or disruption of BBB and inflammatory reaction in mild brain injury associated with explosive shock wave and effects of early intervention of oxidative stress injury, repairing the BBB and blocking inflammation on relieving delayed neurological deficits.

The short-term prognosis evaluation model for the first ischemic cerebral stroke patients / 实用医学杂志

Objective To explore common risk factors of the first acute ischemic cerebral stroke patients′neurological deficits and build a short-term prognosis model. Methods 89 hospitalized patients with acute is-chemic cerebral stroke were chosen for study from September 2014 to December 2015 in the Fifth Affiliated Hos-pital of Zhengzhou University. Our study′s evaluation methods were using the unified questionnaires , the NIHSS score and the mRS scale. Results Traditional risk factors were no significant difference among the three groups (P > 0.05); 6 kinds of hematology indexes such as WBC count had significant difference in NIHSS score (P <0.05) and prognosis(P < 0.05); 6 kinds of hematology indexes such as D-D and the NIHSS score had a signifi-cant effect on prognosis (OR = 1.800, 0.976, 1.112, 1.327, 5.564, 6.456, 1.227); the area under ROC curve was 0.976, which proved the model had a good predictive value. Conclusion Traditional risk factors had no significant difference among the different neurological deficits groups; 6 kinds of hematology indexes such as D-D and NIHSS score on admission had a significant influence on prognosis; the model predicted the short-term prognosis of acute ischemic cerebral stroke more accurately.

Clinical study of acute spinal spontaneous hematoma / 中华急诊医学杂志

Objective To evaluate the etiology, pathogenesis, clinical manifestation, imaging features, treatments and factors related to prognosis of acute spinal spontaneous hematoma.Methods The clinical data of 38 patients with acute spinal hematoma treated in our hospital from 2011 till now were analyzed retrospectively.Duration of follow-up was 6 months.The factors influencing the prognosis were analyzed.Results Acute epidural hematomas (n=29) were much more common than subdural (n=5), subarachnoid (n=1) and intramedullary (n=3).Most hematomas were located in the cervical and thoracic vertebra regions.The etiology of acute spinal spontaneous hematoma was unknown in most patients.Twenty-nine patients were dealt with surgical intervention and 9 patients were treated conservatively.After 6-month follow up, recovery rate measured by JOA score in patients of spinal injury ASIA level A and B was (51.26 ±38.97), and level C, D and E was (80.33 ±25.83), P<0.05.Recovery rate in patients with hematoma discovered in less then 24 hours treated with surgical decompression was (64.79 ±36.10), and that in those with hematoma present over 24 hours was (34.54 ±30.17), P<0.05.Conclusions Acute spinal hematoma always caused by unknown etiology, and usually manifests itself in a sudden onset of pain and neurological deficits.The early diagnosis mainly depends on MRI.Patients presenting with severe neurologic dysfunction or showing signs of progressive deficit should have immediate surgical intervention. The status of neurological deficits before surgery and the length of interval between onset and surgical intervention are associated with recovery.

Morphometric Study of Fourth Ventricle By Computerised Tomography.

Background: The two major changes that may occur in elderly individual without neurologic deficits is enlargement of ventricles and cortical atrophy. Aim of the study was to statistically analyse the dimensions of Fourth ventricle in humans and also to study the Changes that occur during ageing. Ventricular size of males and females was compared. METHOD: The CT images of 112 adult individuals (Age Group 21-60) and 88 ageing individuals (Age above 61) was studied in both males and females. Measurements like vertical length, height, anterior-posterior diameter and transverse diameter of fourth ventricle was made by using dicomworks software. RESULT: This study showed positive co-relation of age with dimensions of fourth ventricle and the dimensions of the fourth ventricle were enlarged with physiologic ageing. Also the dimensions of fourth ventricle were more in males as compared to females.

Dynamic Observation of the Effect of Acupuncture on ROCKExpression in A Rat Model of Cerebral Ischemia and Reperfusion / 上海针灸杂志

ObjectiveTo obtain data related to various periods of acupuncture treatment for rat focal ischemia and reperfusion and infer the optimal time point of acupuncture treatment by examining cerebral ROCK expression on the ischemic side in different periods of acupuncture for rats with focal ischemia and reperfusion.MethodOne hundred andeighty male adult Wistar rats were enrolled and randomly allocated to blank, sham operation, model and acupuncture groups. The model and acupuncture groups were separately divided into 5 subgroups: the 6 h, 24 h, 48 h, 72 h and 2 w subgroups. There were atotal of 12 groups, 15 rats each. An animal model of focal cerebral ischemia was made using a thread occlusion method for obstructing rat right middle cerebral artery. The carotid artery was only separated in the sham operation. Materials were taken in the blank and sham operation groups on day 2 after model making. Materials were taken for examination in every subgroup of the model group at 6, 24, 48 and 72 hours and 2 weeks after model making. Materials were taken for examination after acupuncture at Baihui(GV20), Dazhui(GV14)and Zusanli (ST36)in every subgroup of the acupuncture group at 6, 24, 48 and 72 hours and 2 weeks after model making.ResultAcupuncture markedly improved neurological deficits in rats with cerebral ischemia and reperfusion. Areduction in the neurological deficit score was largest in the 6 h acupuncture group and there was a statistically significant difference compared with the other acupuncture groups (24 h, 48 h and 72 h) (P0.05). There was a statistically significant difference in ROCK expression between the model (ischemia-reperfusion 6 h, 24 h, 48 h and 72 h) and blank groups (P<0.05). ROCK expressionreached the peak value at 6 hours after ischemia and reperfusion. There was a statistically significant point-to-point difference in ROCK expression between the acupuncture (ischemia-reperfusion 6 h, 24 h, 48 h and 72 h) and model (ischemia-reperfusion 6h, 24 h, 48 h and 72 h) groups (P<0.05). ROCK expression was down-regulated most markedly in the ischemia-reperfusion 6 h acupuncture group.Conclusion Acupuncture has an inhibitory effect on Rho/Rock in a rat model of cerebral ischemia and reperfusion. Six hours after ischemia and reperfusion is the optimal time point of acupuncture treatment. Acupuncture at that time can protect and improve post-ischemic injured brain tissue to the largest extent.

Effect of kallikrein and ozagrel on hemorheology in the treatment of patients with acute cerebral infarction / 中国基层医药

Objective To observe the effect of kallikrein and ozagrel on hemorheology in the treatment of patients with acute cerebral infarction,provide a theoretical basis for clinical treatment.Methods 100 patients with acute cerebral infarction met the inclusion criteria were randomly divided into 50 cases of observation group and 50 cases of control group,the control group were received conventional drug therapy,the observation group were given kallikrein and ozagrel on the basis of the control group,kallikrein 0.15PNA /times,ozagrel 80mg one time,bid,14d for a course of treatment.The symptoms improvement were observed,the NIHSS score and ADL score were calculated after treatment,then the blood were extraced for detecting high shear viscosity of whole blood,red blood cell aggrega-tion index,hematocrit,fibrinogen,erythrocyte sedimentation rate,and the clinical efficacy were judged.Results The total effective rate of the observation group were 96% (48 /50),which of the control group were 66% (33 /50),the total effective of the observation group was significantly higher than the control group (χ2 =16.105,P <0.01);The high shear viscosity of whole blood,red blood cell aggregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate,NHISS of the observation group and the control group after treatment were lower than before treatment (t =6.589 and 3.762,6.204 and 3.661,8.112 and 5.774,5.542 and 3.529,9.429 and 3.962,9.621 and 6.586,all P <0.05),the ADL score was significantly higher than before treatment(t =7.673 and 5.446,all P <0.05),the high shear viscosity of whole blood,red blood cell aggregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate, NHISS of the observation group after treatment were lower than those of the control group (t =3.387,3.545,3.525, 3.288,3.302,4.988,all P <0.05),the ADL score was significantly higher than the control group (t =3.446,P <0.05).Conclusion The method containing kallikrein and ozagrel has exact clinical efficacy,can effectively improve blood rheology and cerebral blood perfusion ischemic area,promote neurological deficits and recover the ability of daily life,and its security is good,which is worthy of promotion.

Flashback phenomenon and residual neurological deficits after the use of "bath salt" 3, 4- methylenedioxypyrovalerone / 世界急诊医学杂志（英文）

BACKGROUND:The use and abuse of designer drugs has been recognized for decades;however there are many derivatives of compounds that make their way into the community. Abuse of compound(s) known on the street as "bath salt" is on the rise. METHODS:We report the case of a 33-year-old man who complained of "flashbacks"and right arm shaking that followed a night of "bath salt" snorting. The active compound methylenedioxypyrovalerone methamphetamine (MDPV) was confirmed; however, analysis of three different "bath salt" products showed difference in their active components. RESULTS:The patient's symptoms remained stable and he was discharged home after observation in the emergency department with instructions to return for any symptom progression. CONCLUSION:Practitioners should be aware of the abuse of the compounds and that not all"bath salt" products contain MDPV.

Synergistic and protective effects of various combination of major components of YiQiJieDu (YQJD) on focal cerebral ischemia injury based on amino acid metabonomics / 中国药理学通报

Aim To elucidate the therapeutic effect of ginsenosides, berberine and jasminoidin after given a-lone or treatment with combination on the focal cerebral ischemia rats and study the compatibility mechanism. Methods We determined 12 endogenous amino acids in serum of rats after cerebral ischemia over 12 hours with RRLC-QQQ to evaluate the integrated role of YQJD at the dosage of 25 mg·kg-1 and 5 mg·kg-1 . Generally accepted methods were used, including be-havior test, One-Way AVONA, PLS-DA, as well as PCA to evaluate the injury induced by focal cerebral is-chemia. Results The score of neurological deficits and the level of five amino acids, namely Glu, Asp, Met, Hcy, Phe in the combination of ginsenosides, berberine and jasminoidin group in the dosage of 25 mg ·kg-1 and 5 mg·kg-1 significantly decreased (P<0. 05, P<0. 01) compared to those of model group. For another, the largest contribution group in the three principal components of PC1 , PC3 , PC4 at the dosage of 25 mg/kg and the six principal components PC1 ~PC5, PC7 in 5 mg·kg-1 was the combination of gin-senosides, berberine, jasminoidin group. Conclusions The results suggest that the efficacy of the combina-tion of ginsenosides, berberine and jasminoidin is su-perior to the combination of two or any single compo-nent, which can significantly improve the metabolic disorder of the endogenous amino acid after cerebral is-chemia. And it could be speculated that ginsenosides may play a more important role than berberine and jas-minoidin in regulating the level of amino acid metabo-lism.

Cortisol dynamics and endothelin-1/nitric oxide ratio are associated with clinical vasospasme.

Background: Cortisol dynamics in serum might be related to clinical vasospasm, also known as delayed ischemic neurological deficits (DIND). Two vasoactive substances that play a role in pathophysiology of DIND are endothelin-1 (ET1) and nitric oxide (NO), both are proved associated with cortisol. This study aimed to know how cortisol plays a role on ET1/NO ratio and its relationship to DIND. Methods: This was a prospective cohort study for the first 14 days after aneurysmal subarachnoid hemorrhage (SAH). Patients with inclusion criteria will be enrolled for blood test before surgery, and post-operative day 2, 4, 7, and 10 (between 8:00-9:00 AM). The blood tests were performed for cortisol, ACTH, CBG, NO, and ET1. Free cortisol is calculated with Coolens equation. Logistic regression was used to see the interaction model and its scale. Bivariate analysis (corelation) was used to see the relationship between total cortisol, free cortisol, NO, ET1, and clinical vasospasm (DIND). Results: Forty-four patients were enrolled into this study (20 males; 24 females). Mean age was 52.02 ± 11.23 years. There were 29 patients (66%) within DIND group and 15 patients non-DIND as the control group. The mean of cortisol level shown was significantly higher in DIND group (35.99 ± 14.24) μg/dL compared to non-DIND group (19.57 ± 6.19) μg/dL, p < 0.001. The mean of free cortisol level was significantly higher in DIND group (2.06 ± 1.094) μg/dL compared to non-DIND group (0.838 ± 0.365 μg/dL; p < 0.001). The scatter plot graph showed that correlation of cortisol with ET1/NO ratio started increasing on day 4 and became stronger on day 10. Conclusion: Cortisol is associated with DIND following aneurysmal SAH, probably through its role in keeping the balance between ET1 and NO level.

Spontaneous Spinal Epidural Hematoma: A Retrospective Study on Prognostic Factors and Review of the Literature

OBJECTIVES: The spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Patients typically present with sudden onset back pain followed by neurological deficits. METHODS: Diagnosis of SSEH is usually made with MRI and standard treatment is surgical evacuation. In 1996, Groen published the most comprehensive review on the SSEH in which he analyzed 333 cases. We review 104 cases of SSEH presented in the English literature since the last major review and add three of our own cases, for a total of 107 cases. RESULTS: Our patients presented with back pain and neurologic deficits. Two made excellent functional recovery with prompt surgical decompression while one continued to have significant deficits despite evacuation. Better postoperative outcome was associated with less initial neurological dysfunction, shorter time to operation from symptom onset and male patients. CONCLUSION: We discuss the etiology of SSEH and report current trends in diagnosis, treatment, and outcome.

The Utility of Somatosensory Evoked Potential Monitoring During Cervical Spine Surgery: How Often Does It Prompt Intervention and Affect Outcome?

STUDY DESIGN: Retrospective review of the results of somatosensory evoked potentials (SSEP) performed in cervical spine surgery. PURPOSE: To evaluate the utility of spinal cord monitoring during cervical spine surgery in a single surgeon's practice, based on how often it prompted an intraoperative intervention. OVERVIEW OF LITERATURE: Intraoperative monitoring during cervical spine surgery is not a universally accepted standard of care. This is due in part to the paucity of literature regarding the impact of monitoring on patient management or outcome. METHODS: SSEP for tibial, median, and ulnar nerves were monitored in 809 consecutive cervical spine operations performed by a single surgeon. The average patient age was 52 years (range, 2 to 88 years), with 472 males and 339 females. Cases were screened for significant degradation or loss of SSEP data. Specific attention was paid to 1) what interventions were performed in response to the SSEP degradation with subsequent improvement, and 2) whether SSEP changes corresponded with postoperative neurological deficits. RESULTS: Seventeen of 809 patients (2.1%) had SSEP degradation that met warning criteria and therefore prompted intervention. Release of shoulder tape (8) or traction (4) most often resulted in SSEP improvement. Failure of SSEP data to return to within acceptable limits of baseline was associated with neurological deficit (p=0.04). Two patients awoke with new postoperative neurological deficits, which resolved in 6 hours and 2 months respectively. Patients with ossification of the posterior longitudinal ligament (OPLL) were at seven-fold greater risk of intraoperative SSEP degradation. CONCLUSIONS: SSEP monitoring in this surgical population proved sensitive to perioperative factors which may increase the risk of postoperative neurologic deficit, and probably prevented neurological deficits in 15 of 809 patients (1.9%). Improvement in data following intervention appears to correlate well with unchanged neurologic status. Experience with intraoperative monitoring in this patient series has led to incorporation of these techniques as a standard of care in cervical spine surgeries performed by this surgeon.

Outcome of Surgical Management for Tethered Spinal Cord

OBJECTIVE: The tethered cord syndrome results in progressive neurological deficits. Although it may remain controversial, many physicians recommend definitive surgery to untether the cord as soon as this condition is identified. We retrospectively evaluate the pre-operative and post-operative course of 38 tethered cord patients with spinal dysraphism in an attempt to learn the natural history of the disease and to determine the effectiveness of the surgical treatment. METHODS: The medical records, operation notes and radiographs were evaluated. The follow up period ranged from 4 months to 12 years with a mean follow-up of 28.6 months. Twenty-seven patients were younger than 15 years of age. RESULTS: At presentation, 26 of the patients were asymptomatic. In three of 11 adult symptomatic patients, their neurological deficits worsened after trauma or exercise. Improvement of motor strength was documented in two out of 5 patients. Five of nine patients with bladder symptoms improved, however, none had a complete return of their bladder function. CONCLUSION: Childhood patients were less symptomatic than the adult patients. Adult patients showed progression of their symptoms that were not improved even after the operation in most of the cases. Asymptomatic tethered spinal cord can be symptomatic as time passes by and even at an old age. Future research should be focused on the operative methods to prevent the delayed deterioration after surgery, rather than on the usefulness of preventive surgery in asymptomatic patients.

Protective effects of total of flavone c on cerebral ischemia injury in mice / 中国临床药理学与治疗学

AIM: To investigate the protective effects of total of flavone C (TFC) on acute cerebral ischemia in mice and focal cerebral ischemia in rats. METHODS: The occlusion of bilateral common carotid arteries with vagus nerves in mice was used for make the acute cerebral ischemia models. The survival time and the death rate were observed. The permanent occlusion of the proximal of the right middle cerebral artery (MCA) was used for make the focal cerebral ischemia models. The extent of neurological deficits was observed, and the infarct area was measured by NBT staining technique. The activity of LDH and the content of MDA and NO in the ischemic cerebral cortex were determined. RESULTS: TFC of 80 and 40 mg?kg -1 prolonged the survival time and decreased the death rate of mice with acute cerebral ischemia injury. TFC of 60, 30, and 15 mg?kg -1 ameliorated neurologic deficits score and the infarct size of rats with MCAO. CONCLUSION: TFC provides significant protective effects against cerebral ischemia injury.

Role of Acetazolamide Brain SPECT in the Evaluation of Delayed Ischemic Neurological Deficits Following Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: The purpose of this study is to evaluate the role of acetazolamide brain SPECT in the assessment of delayed ischemic neurological deficits(DINDs) following aneurysmal subarachnoid hemorrhage. METHODS: Prospective analysis of consecutive patients with aneurysmal subarachnoid hemorrhage was made from July 1999 to December 2000. Regular neurological examination and Transcranial Doppler(TCD) monitoring were done for monitoring development of DINDs. Postoperative cerebral angiography and acetazolamide brain SPECT were performed according to our spasm-monitoring algorithm. Correlation of three diagnostic tools with development of DINDs was evaluated and concordance rates between each diagnostic tool were investigated. RESULTS: A total of 65 patients were included. DINDs were developed in 44.6% of patients. Spasm evidences on TCD monitoring, cerebral angiography and acetazolamide brain SPECT were observed in 38.5%, 40.0%, 41.5% of patients. Although there is no statistical significance, acetazolamide brain SPECT was more correlated with DINDs development than other two tools. Spasm evidence on TCD were not proceeded the development of DINDs in 58.6% of patients with DINDs. Concordance rate between acetazolamide brain SPECT and cerebral angiography was highest. However, there are significant numbers of discordance between two tools. CONCLUSION: Three diagnostic tools are complementary to each other in the assessment of DINDs. However, considering that DINDs is basically attributable to cerebral hemodynamic alteration rather than arterial morphologic change, acetazolamide brain SPECT seems to be the most useful tool in the evaluation of DINDs.

Clinical study of early rehabilitation therapy of stroke patients / 中华物理医学与康复杂志

Objective To study the effect of early rehabilitation intervention on neurological deficits,equilibrium function, motor function and activities of daily life abilities in stroke patients. Methods Sixty two patients with acute stroke were allocated randomly into two groups: rehabilitation group and control group. The patients in the rehabilitation group were treated with a comprehensive rehabilitation regimen including the clinical treatment,Bobath technique, PNF technique and neuromuscular stimulation therapy. The patients in the control group were treated with medications. Neurological deficits,equilibrium function,motor function and ADL of all the patients were assessed before and after 28 days of rehabilitation intervention. Results The neurological deficit scores were reduced, while equilibrium function and motor function and ADL were increased after therapy in the two groups. The difference was significant ( P

Unilateral Lower Limb Paralysis after Abdominal Hysterectomy: A case report / 대한마취과학회지

Postoperative neurological deficits are uncommon and may arise from diverse causes, and persistent neurological complications resulting from epidural anesthesia are extremely rare. We experienced a case of unilateral lower limb paralysis in a patient after abdominal hysterectomy under general and epidural analgesia. The condition persisted for more than several weeks despite gradual improvement, and believed to have resulted from epidural analgesia. However, neurological examination, electromyography (EMG) and nerve conduction study (NCS) revealed isolated peripheral femoral neuropathy rather than radiculopathy. This neurological deficit seemed to have been caused by the self-retaining retractor, used intraoperatively. If the cause of a neurological complication is peripheral neuropathy, then it is probably associated with the surgical procedure rather than the anesthetic procedure.