Amyotrophic lateral sclerosis diagnosed after lumbar epidural block for treating low back pain: Two cases report

Lumbar epidural block is one of effective methods for treating low back pain with or without radiculopathy. However, neurologic complications can occur after epidural block due to several causes such as direct nerve injury or epidural hematoma. It is important to determine whether the neurologic complication is related to the procedure or is due to the underlying neurologic disease. We report two cases of patients who complained of weakness in their lower extremities after receiving a lumbar epidural block; they were ultimately diagnosed with amyotrophic lateral sclerosis.

Common peroneal injury mistaken neuraxial analgesia complication after vaginal delivery: A case report

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.

Hand, Foot, and Mouth Disease Neurologic Complications: Clinical Features and Parameters / 대한소아신경학회지

PURPOSE: Hand, foot, and mouth disease (HFMD) is a common childhood illness. Enterovirus 71 (EV71) epidemics have recently been associated with HFMD-based neurologic complications in the Asia-Pacific region. This study described HFMD clinical features, and investigated clinical parameters in patients presenting with acute neurologic complications associated with HFMD. METHODS: We retrospectively reviewed medical records from 235 hospitalized patients who developed HFMD with or without neurologic complications (22 and 213 cases, respectively) in Uijengbu, Korea between 2010 and 2013. Clinical manifestations, radiologic findings, cerebrospinal fluid (CSF) analyses, virological analyses, and treatment regimens were summarized. Additionally, routinely collected baseline data from 235 patients were retrospectively analyzed to identify clinical parameters associated with neurologic complications. RESULTS: Brainstem encephalitis was the most frequent neurologic complication (11 cases), followed by aseptic meningitis (seven cases). We also found acute disseminated encephalomyelitis and meningitis retention syndrome. Both have rarely been reported in EV71-associated HFMD. Virological analyses were performed for 15 cases, and 14 demonstrated EV71 infection, while one patient demonstrated Coxsackievirus B3 infection. Multivariate logistic regression analysis indicated patients were more likely to develop neurologic complications if they experienced nausea/vomiting (OR= 13.65, P<0.001) and lethargy (OR=10.68, P=0.003). Males were more likely to develop neurologic complications compared to females (OR=2.12, P=0.005). In addition, neurologic complications were associated with a higher peak heart rate (OR=1.13, P=0.001). CONCLUSION: This study revealed usual and unusual findings of HFMD-associated neurologic complications. Male gender, nausea/vomiting, lethargy, and peak heart rate parameters predicted HFMD-associated neurologic complications. However, laboratory findings did not reliably predict HFMD-associated neurologic complications.

Non-neurologic complications following surgery for scoliosis / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for scoliosis and to identify factors that can increase this risk. METHODS: The demographic data, medical and surgical histories, and prevalence of non-neurologic complications were reviewed in a retrospective cohort of 602 patients, who had undergone corrective surgery for scoliosis between January 2001 and June 2011. RESULTS: There were 450 patients under 20 years old (U20) and 152 of patients above 20 years old (A20) enrolled in this study. Forty-nine patients in U20 (10.9%) and 18 patients in A20 (11.8%) had post-operative complications. Respiratory complications were most common in U20 (4%) and gastrointestinal complications were most common in A20 (7%). There was no significant difference between the 2 groups in the prevalence of complications. Logistic regression revealed that factors that correlated with an increased odds for complications were Cobb angle (P = 0.001/P = 0.013, respectively), length of operation time (P = 0.003/P = 0.006, respectively), duration of anesthesia (P < 0.001/P = 0.005, respectively) and transfusion (P = 0.003/P = 0.015, respectively) in U20 and A20. Also, comorbidities (P = 0.021) in U20, and decreased body mass index (P = 0.030), pre-operative forced vital capacity (P = 0.001), forced expired volume in 1s (P = 0.001), increased numbers of vertebrae fused (P = 0.004), blood loss (P = 0.001) in A20 were associated with increased odds for complications. CONCLUSIONS: There was no difference in the prevalence of complication in scoliosis patients by age. The prevalence of complication was dependent on Cobb angle, length of operation time, duration of anesthesia and transfusion of PRBC. Deterioration of preoperative pulmonary function significantly increased risk of post-operative complications in adult patients.

Neurologic Complications and Outcomes of Pandemic (H1N1) 2009 in Korean Children

Neurologic complications of children with influenza A H1N1 2009 pandemic, diagnosed in two consecutive influenza seasons were retrospectively reviewed to seek better outcomes in future outbreaks. Patient demographics, clinical manifestations and neurologic outcomes were reviewed. A total of 1,389 children were diagnosed with influenza A H1N1 by real-time reverse transcriptase-polymerase chain reaction. Of these, 23 (1.7%) patients had neurologic involvement. Their mean age was 5.9 +/- 3.6 yr (range, 6 months to 11 yr) and 16 (69.9%) were boys. None of the 23 patients had been vaccinated for influenza A H1N1 and seasonal influenzas. Twenty-two of the 23 patients presented with seizures. Clinical features included febrile convulsion (n = 19), afebrile convulsion (n = 1), aseptic meningitis (n = 1), encephalopathy (n = 1), and acute necrotizing encephalopathy (n = 1). They all were treated with Oseltamivir twice daily for 5 days immediately after nasal and throat swab testing. Twenty-one of the subjects recovered fully, but the youngest two infants experienced severe neurological sequelae. The results indicate that neurologic complications associated with influenza A H1N1 2009 pandemic were mostly mild, but rarely were serious. Prompt intervention leads to a better outcome and vaccination may prevent the disease, thus staving off serious neurological complications following influenza, especially in young infants.

Perioperative cerebral infarct during cardiac surgery and changes in jugular venous O2 saturation and cerebral oximetry using near-infrared spectroscopy: A case report / 대한마취과학회지

Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery.

Neurologic Complications Associated with Respiratory Syncytial Virus Infection in Childhood / 대한소아신경학회지

PURPOSE: Respiratory syncytial virus(RSV) mainly brings about respiratory complication, but it can also be related to neurologic complication. We have studied clinical aspect and incidence of neurologic complication associated with RSV infection. METHODS: We reviewed the medical records of 732 children with RSV infection who were admitted to the department of pediatrics, Hanyang University hospital from November 2002 to June 2007 and studied on existence of neurologic complication, age, sex, clinical symptom, characteristics of seizure, and laboratory findings. RESULTS: Neurologic complications were occurred in 52 patients(7.1%) among 732 patients. Among them, 14 patients(1.9%) had seizure and 38 patients(5.2%) had alteration of mental status such as drowsy, lethargy. Age distribution of patients with neurologic complication was from 1 month to 5 years(mean 16.4 months). There were 30 boys and 22 girls. Among 14 patients who had seizure, 2 patients had convulsion disorder, 3 patients had febrile convulsion, and 9 patients had no seizure before. Their age distribution was from 1 months to 4 years(mean 18.4 months) and there were 8 boys and 6 girls. All of 14 patients showed generalized tonic clonic seizure and durations were from 30sec to 15 min(mean 4.4 min). All of the investigations were normal. None of 52 patients had recurrence and neurologic sequelae. CONCLUSION: It is important to know that RSV can cause CNS complications because we know how many patients infected by RSV. RSV-related seizure can be considered as benign seizure which does not need any long-term antiepileptic medication.

Neurologic complications in operations performed in the lithotomy position / 대한산부인과학회지

OBJECTIVE: Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication. MATERIALS AND METHODS: We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period. RESULTS: Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (four patients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01) CONCLUSIONS: In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.

Neurologic Complication after Percutaneous Vertebroplasty with Polymethylmethacrylate: A Case Report / 대한척추외과학회지

In recent years, percutaneous vertebroplasty has frequently been used to treat osteoporotic compression fractures. This procedure is generally known to be safe because of the rare occurrence of complications. However, it is accompanied by the risk of cement leakage, and the cement can be easily removed using a surgical technique. Most neurological complications occurred due to extravasation of cement into the spinal canal. Comparatively, there were no reports of neurological complications due to the extravasation of cement into the paravertebral area. Here, we report a case of right-exiting L1 spinal root compression after percutaneous vertebroplasty with polymethylmethacrylate (PMMA). We proceeded to cement removal and nerve root decompression by a paraspinal open microsurgical technique in the event of neurological complication.

Weakness and Footdrop of Lower Extremity following Spinal Anesthesia: A case report / 대한마취과학회지

Spinal anesthesia has been widely used as a safe and simple procedure. Most complications related with spinal anesthesia are self-limited and respond well to treatment. Nevertheless, neurological complications can be troubling with the use of anesthetics as well as the patients. Here, a case of neurological complication with aggravated pain and weakness of the lower extremities following spinal anesthesia is reported.

Two or Three Times of Short Deep Hypothermic Circulatory Arrest (DHCA)within 20 Minutes, Total Not Exceeding 60 Minutes, Does Not Impair Brain Function in Adults / 대한마취과학회지

BACKGROUND: Deep Hypothermic circulatory Arrest (DHCA) is widely used during heart surgery in neonates and infants and complicated surgeries in adults such as a pulmonary thromboendarterectomy (PTE). However safe limits of time and temperature during DHCA still remain controversial. Futhermore it's effects on neurologic outcome has been controversial. METHODS: On the postoperative 3 days, we examined the neurologic function of 12 patients who received a PTE. During the PTE, DHCA was done 2 or 3 times within 20 minutes. Between DHCAs the patients were perfused at a low flow rate with 18degreesC blood until their venous saturation returned to 90%. Neurologic evaluations included level of consciousness, Glasgow coma scale (GCS), and motor and sensory functions. RESULTS: Neurologic functions of all of the patients assessed on the 3 days postoperatively was grossly normal. All 12 patients were oriented to time, place, and person with normal gross motor and sensory functions. CONCLUSIONS: No significant neurologic complications were related to the technique of two or three times of short DHCA within 20 minutes, for a total not exceeding 60 minutes.

Neurologic Complication after Spine Surgery / 대한정형외과학회잡지

We examined the rates of postoperative neurologic complications, as recorded in the medical record department in Severance Hospital from 1989 through 1991 for patients who had had operations on the spine. There were 538 hospitalizations for procedures on the spine; 327(60.78%) of herniated disc, 120(22.30%) of spondylolisthesis, 64(11.90%) of infection, 27(5.02%) of spinal stenosis were included. Neurologic complications oecurred in 12(2.23%) patients; 3 cases in herniated disc, 4 in spinal stenosis, 4 in spondylolisthesis, and 1 in infection. Regarding techniques of the operation, 8 complications occurred in arthrodesis, among these, 2 were in anterior approach and 6 in posterior approach. Four cases of the complications occurred in laminectomy and discectomy procedure. Complications were more frequent in the patients who had had spinal stenosis when arthrodesis was performed than decompression procedure only. Possible causes of neurologic complication were postoperative hematoma formation, translation of the vertebral column due to instability after anterior debridement and forceful traction of the nerve root during the operation.