ABSTRACT
INTRODUCTION: Shoulder surgery is often performed with the patient in the so called "beach-chair position" with elevation of the upper part of the body. The anesthetic procedure can be general anesthesia and/or regional block, usually interscalenic brachial plexus block. We present a case of brachial plexus palsy with a possible mechanism of traction based on the electromyographic and clinical findings, although a possible contribution of nerve block cannot be excluded. PRESENTATION OF THE CASE: We present a case of a 62 year-old female, that suffered from shoulder fracture-dislocation. Open reduction and internal fixation were performed in the so-called "beach-chair" position, under combined general-regional anesthesia. In the postoperative period complete motor brachial plexus palsy appeared, with neuropathic pain. Conservative treatment included analgesic drugs, neuromodulators, B-vitamin complex and physiotherapy. Spontaneous recovery appeared at 11 months. DISCUSION: in shoulder surgery, there may be complications related to both anesthetic technique and patient positioning/surgical maneuvers. Regional block often acts as a confusing factor when neurologic damage appears after surgery. Intraoperative maneuvers may cause eventual traction of the brachial plexus, and may be favored by the fixed position of the head using the accessory of the operating table in the beach-chair position. CONCLUSION: When postoperative brachial plexus palsy appears, nerve block is a confusing factor that tends to be attributed as the cause of palsy by the orthopedic surgeon. The beach chair position may predispose brachial plexus traction injury. The head and neck position should be regularly checked during long procedures, as intraoperative maneuvers may cause eventual traction of the brachial plexus.
ABSTRACT
Introducción: la relación entre cefalea y sueño es conocida desde hace muchos años. El sueño y la cefalea tienen una fuerte interacción bidireccional, y comparten elementos anatómicos y fisiológicos. La intención de la presente revisión es presentar los distintos tipos de cefaleas relacionadas con el sueño y su aproximación fisiopatológica. Desarrollo: exponemos los distintos tipos de cefaleas relacionadas con el sueño, es decir aquellas que ocurren durante la noche o en las primeras horas de la mañana, la migraña, la cefalea en racimo, la hemicránea crónica paroxística y la cefalea hípnica. También, desarrollamos el síndrome de la cabeza que explota o síndrome del estallido cefálico, puesto que en la práctica clínica debe ser valorado en el diagnóstico diferencial de las cefaleas relacionadas con el sueño. Conclusión: se necesita una mayor investigación en el tema para establecer conclusiones, esclarecer los mecanismos fisiopatológicos entre cefalea y sueño, así como entender cómo los cambios en la biología del sueño provocan dolor de cabeza y por qué los distintos tipos de cefaleas afectan a la biología del sueño (AU)
Introduction: the link between cephalalgia and sleep has been known for many years. Sleep and cephalalgia have a strong bidirectional interaction and share anatomical and physiological aspects. The intention of this paper is to present the different types of cephalalgias related with sleep and their physiopathological closeness. Discussion: different types of cephalalgia related with sleep will be exposed. That is, cephalalgia that occurs at night time or first time in the morning: migraine, cluster headache, chronic hemicrania continua and hypnic headaches. We also review the exploding head syndrome since it should be assessed in differential diagnosis when looking at sleep-related cephalalgias. Conclusions: further research is needed on this subject in order to establish conclusions, to clarify physiopathological mechanisms between cephalalgia and sleep and to understand how changes in sleep biology cause headaches and why different types of cephalalgias affect sleep biology (AU)
Subject(s)
Humans , Male , Female , Headache Disorders/complications , Headache Disorders/diagnosis , Headache/complications , Sleep/physiology , Cluster Headache/complications , Cluster Headache/diagnosis , Paroxysmal Hemicrania/complications , Paroxysmal Hemicrania/diagnosis , Migraine Disorders/complications , Migraine Disorders/diagnosis , Chronobiology Phenomena/physiology , Chronobiology Discipline/methods , Chronobiology Discipline/trends , Polysomnography/methods , Polysomnography/trends , PolysomnographyABSTRACT
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