Abstract Details

Title Postsurgical Inflammatory Neuropathy: A Report of Four Cases

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 132

Objective

Background BACKGROUND: Clinical and pathologic descriptions of inflammatory neuropathy following surgery have been reported.

Design/Methods DESIGN/METHODS: Case review with descriptive statistics.

Results RESULTS: Four patients (three women; ages 35 to 63 years) were diagnosed of post-surgical inflammatory neuropathy recently. Surgical procedures included lumbar spine, hip, ankle and foot surgeries. All patients developed acute or subacute onset of symptoms in one or both lower extremities within 30 days after the procedures. The symptoms were foot weakness, numbness, pain and walking difficulty. Laboratory workups including cerebrospinal fluid (CSF) analysis and neuroimaging studies were unable to identify the other causes. Electrophysiological studies revealed mononeuropathy or polyneuropathy with active denervation. Nerve biopsies showed ischemic injury (decreased density of myelinated fibers in all [multifocal in 2], perineurial thickening [1] and neovascularization [1]) and perivascular inflammatory collections in all cases with one being diagnostic of microvasculitis. Three patients who responded to the treatment with 12-weekly intravenous corticosteroid, were seen within 1 year after the onset. The patient who was unresponsive to treatment was seen more than 2 years after onset.

Conclusions CONCLUSIONS: The study illustrates variability of clinical presentation and responses to immunotherapy of postsurgical inflammatory neuropathy. Treatment with 12 weeks of intravenous corticosteroid showed favorable outcomes and tolerability. The study illustrates the importance for physicians to consider inflammatory (not just mechanical) causes of neuropathy in the post-surgical setting as they are not uncommon and are potentially treatable, especially early in the disease.

Authors/Disclosures
Watcharasarn Rattananan, MD (Police General Hospital) PRESENTER	An immediate family member of Dr. Rattananan has received personal compensation for serving as an employee of DKSH (Thailand) Ltd.. Dr. Rattananan has or had stock in Welltower Inc..Dr. Rattananan has or had stock in Viatris Inc..Dr. Rattananan has received publishing royalties from a publication relating to health care.
Pariwat Thaisetthawatkul, MD, FAAN (University of Nebraska Medical Center)	Dr. Thaisetthawatkul has nothing to disclose.
P. James B. Dyck, MD, FAAN (Mayo Clinic)	Dr. Dyck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea/Ionis.
	No disclosure on file