Inherited Neuropathy Can Cause Postpartum Foot Drop

Hereditary Neuropathy with Liability to Pressure Palsy and Vocal Cord Paralysis After Pulmonary Lobectomy: A Case Report

Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare peripheral neurological disorder that manifests with increased sensitivity to pressure. In people with this disorder, the peripheral nerves are unusually sensitive to pressure. Minor trauma or compression causing paralysis in the extremities is a hallmark of this disorder. Ensuring there is no pressure on the extremities is recommended as a preventive measure. We describe for the first time, postoperative vocal cord paralysis in a patient with HNPP due to left recurrent laryngeal nerve palsy. Anesthesiologists and surgeons should be aware of this possible complication in patients with HNPP.

An Unusual Postoperative Neuropathy: Foot Drop Contralateral to the Lateral Decubitus Position

Postoperative neuropathy is often related to surgical positioning or improper padding during surgery. However, other causes should be considered, particularly when the deficit does not correlate with a positioning error. A case is presented of a 15-year-old girl who experienced postoperative foot drop contralateral to the lateral decubitus position. Further evaluation led to a clinical diagnosis of hereditary neuropathy with liability to pressure palsies that predisposed the patient to the injury. Anesthesiologists should suspect hereditary neuropathy with liability to pressure palsies in patients presenting for multiple nerve decompression surgeries and be vigilant in the perioperative handling of these susceptible individuals.

[Pressure-sensitive neuropathy after obstetric delivery with epidural analgesia]

We report the case of a woman who requested epidural analgesia for labor in whom catheterization of the epidural space was difficult, requiring multiple punctures; furthermore, the epidural block was followed by a long expulsion phase in the delivery room. Shortly after delivery the patient experienced paresthesia and weakness in her lower limbs. A diagnosis of pressure-sensitive, or tomaculous neuropathy was based on clinical observation and neurophysiologic and genetic studies. This hereditary disease, which affects peripheral nerve myelin, involves recurrent episodes of focal demyelination when nerves are injured slightly or compressed. This condition is probably underdiagnosed, as there are very few references to it in the literature on anesthesia.

Neuromuscular disorders in pregnancy

Many neuromuscular conditions occur more frequently during pregnancy and include carpal tunnel syndrome, Bell's palsy, lumbosacral radiculopathy, meralgia paresthetica, intercostal neuralgia, and other compression neuropathies. Preexisting or coincident neuromuscular diseases, including demyelinating polyneuropathies, inflammatory muscle disease, myasthenia gravis, and inherited nerve and muscle disease present specific problems during pregnancy. We review management of neuromuscular disorders during pregnancy, labor, delivery, and the early postpartum period.

Neurologic complications of neuraxial analgesia for labor

PURPOSE OF REVIEW

In today's anesthesia practice, provision of neuraxial anesthesia and analgesia is increasing. Along with the patient's fear of paralysis that accompanies placement of a needle near the spinal cord, any subsequent nerve deficit is usually blamed on the neuraxial block provided. Knowing the side effects from labor, neuraxial anesthesia or both is important as anesthesiologists are the first consultants to evaluate whenever a complication arises in these patients if there is a sensory or motor deficit in the lower extremities.

RECENT FINDINGS

Neuraxial anesthesia may be associated with complaints of back pain, postdural puncture headache and severe complications (e.g., hematoma, abscess), but most complications following neuraxial blocks are associated with pregnancy and delivery, not the anesthetic. Signs and symptoms of the most common neurologic complications are described so that the clinician can promptly diagnose and treat these patients and seek appropriate consultation.

SUMMARY

Even though the incidence of true neurologic complications arising from neuraxial anesthesia is not known, they appear to be very rare. As anesthesiologists, providing care encompasses knowing the side effects and complications of the anesthetic we provide. Many of the nerve palsies that present in the postpartum patient may be of an obstetric origin, but anesthesiologists should be aware of anesthetic-related complications.