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Chapter 60. Assessment of Neurologic Complications of Regional Anesthesia

Which of the following diagnosed causes of nerve injury is described as a nonanesthetic/operative-related cause of nerve injury?

A. Inflammation

B. Intraoperative patient positioning

C. Hematoma

D. Use of tourniquet

A is correct. Inflammation or even postoperative infection not immediately related to the surgical site is often overlooked and therefore has a late diagnosis. Of course, without using proper sterile techniques, these infections or inflammations can also be caused by direct needle-nerve contact; that onset is much faster.

B is incorrect. Immobilization and compression by casting can both contribute to nerve injury and they can occur even without anesthesia and surgery. However, intraoperative patient positioning is completely anesthetic/operative-related.

C is incorrect. Hematomas are always operative- or even anesthetic-related. The onset can be slow, with symptoms only appearing after 1 or even 2 days. However, usually hematomas are diagnosed faster and are devastating if unrecognized. Anticoagulation and bleeding diathesis are predisposing factors; some surgeries such as Latarjet shoulder surgery also have a high incidence of hematoma formation.

D is incorrect. The use of a tourniquet is a predisposing factor but is surgery-related.

Which statement is true in the setting of neuraxial anesthesia and concern for spinal cord dysfunction?

A. A CT scan is preferred over an MRI for quicker diagnosis.

B. A CT scan should be performed as quickly as possible if an MRI is unavailable and transfer to a facility with MRI proves difficult.

C. An immediate CT myelography should be performed as quickly as possible.

D. In the absence of MRI, obtaining a neurological consultation should be done first followed by a CT scan.

B is correct. Imaging should never ever be delayed if an MRI takes too long to arrange. A CT scan or CT myelography can then be performed instead.

A is incorrect. An MRI is the preferred imaging modality and gives more accurate information and possible diagnosis.

C is incorrect. A CT myelography or even a CT is a possibility for urgent neuroimaging; however, it should be used as quickly as possible only in the total absence of MRI scanning options.

D is incorrect. A neurological examination or consultation should never slow neuroimaging, not even in the absence of an MRI. CT scan has priority over all at that moment.

A possible epidural hematoma ...

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