Department of Neurology, Washington University School of Medicine, Saint Louis, MO.
Medicine (Baltimore). 2021 Apr 30;100(17):e25698. doi: 10.1097/MD.0000000000025698.
Peripheral nerve injury related to vascular complications associated with extracorporeal membrane oxygenation (ECMO) is perhaps underappreciated. Compared to the well-described central nervous system complications of ECMO, brachial plexopathy and lumbosacral plexopathy have rarely been reported. We report this case to heighten awareness of lumbosacral plexus injury due to pelvic hematoma formation after ECMO.
A 53-year-old woman developed a large pelvic hematoma with significant mass effect on intrapelvic structures after receiving lifesaving venoarterial ECMO for cardiogenic shock following a cardiac arrest. During her hospital course, she developed bilateral foot drop that was attributed to critical illness. Her lack of neurological recovery after 6 months prompted referral to neuromuscular medicine for consultation.
The patient was retrospectively diagnosed with bilateral lumbosacral plexopathy due to the large pelvic hematoma.
Electromyography/nerve conduction study (EMG/NCS) obtained at the time of referral to neuromuscular medicine localized her neurological deficits to the bilateral lumbosacral plexus and demonstrated no volitional motor unit action potentials in her lower leg muscles.
The patient had minimal recovery of strength at the level of the ankles but was ambulatory with solid ankle-foot orthoses due to spared proximal lower extremity strength. Unfortunately, the absence of any volitionally activated motor unit action potentials in her lower leg muscles on EMG performed 6 months after the initial injury was a poor prognostic indicator for successful reinnervation and future neurological recovery.
Neurological deficits occurring during the course of administration of ECMO require accurate localization. Neurology consultation and/or EMG/NCS may be useful if localization is not clear. Lesions localizing to the lumbosacral plexus should prompt radiographic evaluation with computed tomography of the abdomen and pelvis. Hemostasis of a retroperitoneal hematoma may be achieved with embolization. However, if neurological deficits do not improve, surgical consultation for hematoma evacuation may be warranted.
体外膜肺氧合（ECMO）相关的血管并发症引起的周围神经损伤可能被低估了。与 ECMO 引起的中枢神经系统并发症相比，臂丛神经病和腰骶丛神经病很少见。我们报告这例病例是为了提高对 ECMO 后骨盆血肿形成导致腰骶丛神经损伤的认识。
一名 53 岁女性在心脏骤停后因心源性休克接受了救命的静脉动脉 ECMO，之后出现了一个大的骨盆血肿，对盆腔内结构有明显的占位效应。在住院期间，她出现了双侧足下垂，被归因于危重病。6 个月后，她仍未恢复神经功能，因此被转介到神经肌肉科进行咨询。
该患者被回顾性诊断为双侧腰骶丛神经病，病因是大骨盆血肿。
在转介到神经肌肉科时进行的肌电图/神经传导研究（EMG/NCS）将她的神经功能缺损定位在双侧腰骶丛，并在她的小腿肌肉中未发现随意运动单位动作电位。
该患者踝关节水平的力量只有轻微恢复，但由于近端下肢力量未受影响，她可以使用固定踝足矫形器行走。不幸的是，在最初受伤后 6 个月进行的 EMG 中，她的小腿肌肉中没有任何随意激活的运动单位动作电位，这是一个预后不良的指标，表明成功的再神经支配和未来的神经恢复可能性较小。
在 ECMO 治疗过程中出现的神经功能缺损需要准确定位。如果定位不明确，神经科咨询和/或 EMG/NCS 可能会有所帮助。定位在腰骶丛的病变应进行腹部和骨盆 CT 检查。通过栓塞可以止血腹膜后血肿。但是，如果神经功能缺损没有改善，可能需要进行血肿清除的手术咨询。
