Abstract | OBJECTIVE: CASE REPORT: A 17-year old boy with end-stage Legg-Perthes disease presented with severe lower-extremity neuropathy of both legs following bilateral total hip arthroplasty under combined epidural- general anesthesia. A thorough workup excluded potentially devastating and treatable causes, including epidural hematoma or abscess and surgical bleeding or trauma. A neurology consultation and further testing (electromyography, nerve biopsy) resulted in a diagnosis of postsurgical inflammatory neuropathy. Treatment with prolonged, high-dose corticosteroids was undertaken, and although the patient's symptoms improved, he continues to have significant neurologic deficits 8 months after surgery. CONCLUSIONS: Perioperative nerve deficits not readily explained by direct surgical or anesthesia-related causes should prompt early neurologic consultation to seek alternative etiologies such as postsurgical inflammatory neuropathy. Although this condition is poorly understood, it is believed to be an idiopathic immune-mediated response to a physiologic stress (eg, surgery, regional block) and is treated with prolonged, high-dose corticosteroids. Because suppression of the immune system with high-dose steroids may result in improved neurologic outcome, it is essential that surgeons and anesthesiologists are aware of this condition so that treatment is not delayed.
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Authors | Kyle S Ahn, Sandra L Kopp, James C Watson, Kenneth P Scott, Robert T Trousdale, James R Hebl |
Journal | Regional anesthesia and pain medicine
(Reg Anesth Pain Med)
2011 Jul-Aug
Vol. 36
Issue 4
Pg. 403-5
ISSN: 1532-8651 [Electronic] England |
PMID | 21654554
(Publication Type: Case Reports, Journal Article)
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Topics |
- Adolescent
- Arthroplasty, Replacement, Hip
(adverse effects)
- Humans
- Inflammation
(diagnosis, etiology)
- Leg
(innervation, pathology)
- Legg-Calve-Perthes Disease
(pathology, surgery)
- Male
- Peripheral Nerve Injuries
(pathology)
- Postoperative Complications
(diagnosis, etiology, pathology)
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