Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Neural lesions in obstetrics: a diagnostic tree

Neural lesions in obstetrics: a diagnostic tree Lacassie et al. JA Clinical Reports (2022) 8:39 https://doi.org/10.1186/s40981-022-00529-0 Open Access LE T TER TO THE EDITOR 1* 2 3 Hector J. Lacassie , Patricio Mellado and Juan Pablo Cruz To the Editor: 1. Anamnesis We read with great interest the case report by S. Shimizu, a. Previous spine disease (disk herniation, heredi- describing a unilateral radiculopathy due to adhesive tary neuropathy with liability to pressure palsy, arachnoiditis after spinal anesthesia for emergency cesar- diabetes, etc.) ean section. His analysis concludes that there was a local- b. Labor: ized arachnoiditis of the left L5-S1 nerve roots, based on clinical findings and MRI imaging [1]. i. Leg support malposition: common fibular We were puzzled by the clinical presentation and evo- nerve palsy lution of symptoms. It began with hypoesthesia of the ii. Prolonged labor stages and forced leg posi- lateral aspect of the left thigh, resembling meralgia par- tions: femoral nerve or lateral cutaneous esthetica, involving the femoral lateral cutaneous nerve femoral nerve palsy (meralgia paresthetica) (L2-3-4 nerve roots). They also noted motor weakness iii. Instrumental delivery: sacral plexus palsy on dorsiflexion and plantar flexion of the left foot, sug - gesting lumbosacral plexus involvement (L4-S4). There is c. Cesarean section: no other clinical description to allow a definite diagnosis. Also, MRI findings are equivocal and may not support i. Surgical retractors: nerves or sacral plexus the diagnosis of arachnoiditis since nerve roots are not palsies adherent and the dural thickening is most likely due to a ii. Leg malposition: femoral nerve or lateral chemical shift artifact (type 1). cutaneous femoral nerve palsy (meralgia We believe this is a case report of foot drop syndrome paresthetica) in a patient that may have hereditary neuropathy with liability to pressure palsy that can be better described d. Neuraxial anesthesia: Cauda equina syndrome, by ruling out positive and negative findings. This clinical conus medullaris syndrome, or spinal lesion due dilemma is not unusual, especially in obstetrical patients to direct puncture, pharmacological damage, or where neural palsies are due to pregnancy or from infection obstetrical causes, and seldom from anesthesia origin [2]. We present a scheme that can help discriminate clinically 2. Neurological assessment different diagnoses. Clinical assessment for post cesarean section foot drop a. Motor function syndrome. i. No flexion or eversion of the leg + hypoes - thesia of leg and foot: common fibular nerve *Correspondence: lacassie@med.puc.cl ii. No flexion or eversion of the leg + no División de Anestesiología, Facultad de Medicina, Pontificia Universidad abduction of the thigh (gluteus medius mus- Católica de Chile, Marcoleta 377, 4th floor, Santiago, Chile cle): L5 nerve root palsy Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. Lacassie et al. JA Clinical Reports (2022) 8:39 Page 2 of 2 iii. No flexion or eversion of the leg + sphinc - ter incontinence: cauda equina syndrome or lumbosacral palsy b. Sensory function i. Leg and foot hypoesthesia only: superficial fibular nerve ii. Leg and foot hypoesthesia + abolished calcaneal (Achiles’) tendon reflex: sciatic nerve palsy or lumbosacral plexus palsy iii. Bilateral leg hypoesthesia: Cauda equina syndrome or conus medullaris syndrome Acknowledgements Not applicable. Authors’ contributions HL conceived, analyzed, and interpreted the data; PM analyzed and inter- preted the data; JPC analyzed the neuroimages and interpreted the data. All authors read and approved the final manuscript. Funding The current letter had only departmental funding for the writing process. Availability of data and materials Not applicable. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 377, 4th floor, Santiago, Chile. División de Neuro- ciencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Mar - coleta 367, Santiago, Chile. División de Imágenes, Laboratorios y Patologías, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 377, 5th floor, Santiago, Chile. Received: 10 May 2022 Revised: 27 May 2022 Accepted: 30 May 2022 References 1. Shimizu S. Unilateral radiculopathy away from the puncture site due to adhesive arachnoiditis after spinal anesthesia for an emergent cesarean delivery: a case report. JA Clin Rep. 2022;8(1):28. 2. Reynolds F. Neurological infections after neuraxial anesthesia. Anesthesiol Clin. 2008;26(1):23–52. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JA Clinical Reports Springer Journals

Neural lesions in obstetrics: a diagnostic tree

Download PDF
2 pages

Loading next page...
 
/lp/springer-journals/neural-lesions-in-obstetrics-a-diagnostic-tree-lWttg6Jftn

References (2)

Publisher
Springer Journals
Copyright
Copyright © The Author(s) 2022
eISSN
2363-9024
DOI
10.1186/s40981-022-00529-0
Publisher site
See Article on Publisher Site

Abstract

Lacassie et al. JA Clinical Reports (2022) 8:39 https://doi.org/10.1186/s40981-022-00529-0 Open Access LE T TER TO THE EDITOR 1* 2 3 Hector J. Lacassie , Patricio Mellado and Juan Pablo Cruz To the Editor: 1. Anamnesis We read with great interest the case report by S. Shimizu, a. Previous spine disease (disk herniation, heredi- describing a unilateral radiculopathy due to adhesive tary neuropathy with liability to pressure palsy, arachnoiditis after spinal anesthesia for emergency cesar- diabetes, etc.) ean section. His analysis concludes that there was a local- b. Labor: ized arachnoiditis of the left L5-S1 nerve roots, based on clinical findings and MRI imaging [1]. i. Leg support malposition: common fibular We were puzzled by the clinical presentation and evo- nerve palsy lution of symptoms. It began with hypoesthesia of the ii. Prolonged labor stages and forced leg posi- lateral aspect of the left thigh, resembling meralgia par- tions: femoral nerve or lateral cutaneous esthetica, involving the femoral lateral cutaneous nerve femoral nerve palsy (meralgia paresthetica) (L2-3-4 nerve roots). They also noted motor weakness iii. Instrumental delivery: sacral plexus palsy on dorsiflexion and plantar flexion of the left foot, sug - gesting lumbosacral plexus involvement (L4-S4). There is c. Cesarean section: no other clinical description to allow a definite diagnosis. Also, MRI findings are equivocal and may not support i. Surgical retractors: nerves or sacral plexus the diagnosis of arachnoiditis since nerve roots are not palsies adherent and the dural thickening is most likely due to a ii. Leg malposition: femoral nerve or lateral chemical shift artifact (type 1). cutaneous femoral nerve palsy (meralgia We believe this is a case report of foot drop syndrome paresthetica) in a patient that may have hereditary neuropathy with liability to pressure palsy that can be better described d. Neuraxial anesthesia: Cauda equina syndrome, by ruling out positive and negative findings. This clinical conus medullaris syndrome, or spinal lesion due dilemma is not unusual, especially in obstetrical patients to direct puncture, pharmacological damage, or where neural palsies are due to pregnancy or from infection obstetrical causes, and seldom from anesthesia origin [2]. We present a scheme that can help discriminate clinically 2. Neurological assessment different diagnoses. Clinical assessment for post cesarean section foot drop a. Motor function syndrome. i. No flexion or eversion of the leg + hypoes - thesia of leg and foot: common fibular nerve *Correspondence: lacassie@med.puc.cl ii. No flexion or eversion of the leg + no División de Anestesiología, Facultad de Medicina, Pontificia Universidad abduction of the thigh (gluteus medius mus- Católica de Chile, Marcoleta 377, 4th floor, Santiago, Chile cle): L5 nerve root palsy Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. Lacassie et al. JA Clinical Reports (2022) 8:39 Page 2 of 2 iii. No flexion or eversion of the leg + sphinc - ter incontinence: cauda equina syndrome or lumbosacral palsy b. Sensory function i. Leg and foot hypoesthesia only: superficial fibular nerve ii. Leg and foot hypoesthesia + abolished calcaneal (Achiles’) tendon reflex: sciatic nerve palsy or lumbosacral plexus palsy iii. Bilateral leg hypoesthesia: Cauda equina syndrome or conus medullaris syndrome Acknowledgements Not applicable. Authors’ contributions HL conceived, analyzed, and interpreted the data; PM analyzed and inter- preted the data; JPC analyzed the neuroimages and interpreted the data. All authors read and approved the final manuscript. Funding The current letter had only departmental funding for the writing process. Availability of data and materials Not applicable. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 377, 4th floor, Santiago, Chile. División de Neuro- ciencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Mar - coleta 367, Santiago, Chile. División de Imágenes, Laboratorios y Patologías, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 377, 5th floor, Santiago, Chile. Received: 10 May 2022 Revised: 27 May 2022 Accepted: 30 May 2022 References 1. Shimizu S. Unilateral radiculopathy away from the puncture site due to adhesive arachnoiditis after spinal anesthesia for an emergent cesarean delivery: a case report. JA Clin Rep. 2022;8(1):28. 2. Reynolds F. Neurological infections after neuraxial anesthesia. Anesthesiol Clin. 2008;26(1):23–52. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations.

Journal

JA Clinical Reports – Springer Journals

Published: Jun 7, 2022

There are no references for this article.