Spitzer Daniel, Wenger Katharina J, Neef Vanessa, Divé Iris, Schaller-Paule Martin A, Jahnke Kolja, Kell Christian, Foerch Christian, Burger Michael C
Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
J Clin Med. 2021 Mar 2;10(5):1013. doi: 10.3390/jcm10051013.
Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.
在手术环境中，局部麻醉剂通常通过颈部浸润给药，以提供临时的肌间沟臂丛神经阻滞（ISB）。尽管局部麻醉剂引起中枢神经系统毒性的报道较少，但仍有可能发生。在本病例研究中，我们介绍了3例在ISB过程中因局部麻醉剂导致急性中枢神经系统毒性的患者，重点关注其神经症状、关键的神经影像学表现和功能转归。分析了3例在左ISB期间因局部麻醉剂导致中毒性左半球综合征患者的病史、临床和影像学表现以及转归。所有患者均于2016年11月至2019年9月期间入住我们的神经重症监护病房。所有3例患者临床状况均较差，意识障碍并伴有左半球综合征。脑电图显示所有患者患侧半球均有慢波活动。1例患者出现癫痫发作并进展为癫痫持续状态。在3例患者中的2例，磁共振成像显示左侧颈内动脉供血区域有皮质FLAIR高信号和扩散受限。神经严重程度评分评估显示神经症状有自发的部分可逆性。ISB期间局部麻醉剂引起的中枢神经系统毒性可导致严重的神经功能损害和解剖学上可变的脑损伤。
