Peripheral neuropathy

doi:10.1017/CBO9780511544552.012

11 - Peripheral neuropathy

from Section 3 - Nervous system disorders

Published online by Cambridge University Press: 19 October 2009

Felicity Reynolds

Edited by

David R. Gambling ,

M. Joanne Douglas and

Robert S. F. McKay

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Felicity Reynolds: Affiliation:
Emeritus Professor of Obstetric Anaesthesia, St Thomas's Hospital, London, UK
David R. Gambling: Affiliation:
University of California, San Diego
M. Joanne Douglas: Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay: Affiliation:
University of Kansas

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Summary

Introduction

Peripheral neuropathy takes many forms and may occur as a primary condition or as a component of many diseases with multisystem manifestations. There are manifold etiologies: genetic, inflammatory, traumatic/compressive, metabolic, vasculitic, neoplastic, dietary, toxic/drug-induced. They may be classified as mononeuropathy, plexopathy, multifocal neuropathy (mononeuropathy multiplex), or polyneuropathy. They may affect primarily the cell body and/or the axon (neuropathy, axonopathy), or the myelin sheath (demyelinating neuropathy/neurapraxia). As these categories are confused and confusing, and of little use to the anesthesiologist, a simple etiological classification is used here (Table 11.1).

Neuropathies may affect sensory, motor, or autonomic nerves, or a combination. Longer neurons are usually the most susceptible, so a predominantly distal distribution is common. Signs and symptoms may include muscle weakness and wasting, peripheral in onset, usually affecting the lower limbs first, with loss of tendon reflexes and sometimes with fasciculation, glove and stocking sensory loss, paresthesias, spontaneous pain, and autonomic dysfunction.

Pregnancy may exacerbate some neuropathies, while pregnancy or parturition may be a direct or indirect cause of a variety of mononeuropathies and plexopathies, many of which may be incorrectly attributed to neuraxial anesthesia. Some peripheral neuropathies may alter drug sensitivity or impair respiration, and therefore present special challenges to the anesthesiologist. Pregnancy can also cause physical deterioration in restrictive respiratory disease, particularly if associated with scoliosis; it is important to remember that relief does not follow immediately after delivery, so the puerperium can be a dangerous time.

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Type: Chapter
Information: Obstetric Anesthesia and Uncommon Disorders , pp. 215 - 228

DOI: https://doi.org/10.1017/CBO9780511544552.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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References

Thomas P. K. Diseases of peripheral nerves. In Warrell, D. A., Cox, T. M. & Firth, J. D. (eds.), Oxford Textbook of Medicine, 4th edn. Oxford University Press, 2005; pp. 1180–93.

Lennox, G. G. Neurological disease in pregnancy. In Warrell, D. A., Cox, T. M. & Firth, J. D. (eds.), Oxford Textbook of Medicine, 4th edn. Oxford University Press, 2005; pp. 436–9.

Turbridy, N. & Redmond, J. M. T.Neurological symptoms attributed to epidural analgesia in labour: an observational study of seven cases. Br. J. Obstet. Gynaecol. 1996; 103: 832–3.Google Scholar

Confidential Enquiry into Maternal and Child Health. Why Mothers Die 1979–81. London: RCOG Press, 1986.

Reynolds, F.Scoliosis and motherhood. SOAP Newsletter 1990; 22: 4–8.Google Scholar

Rudnik-Schoneborn, S., Rohrig, D., Nicholson, G. & Zerres, K.Pregnancy and delivery in Charcot-Marie-Tooth disease type 1. Neurology 1993; 43: 2011–16.Google Scholar

Byrne, D. L., Chappatte, O. A., Spencer, G. T. & Raju, K. S.Pregnancy complicated by Charcot-Marie-Tooth disease, requiring intermittent ventilation. Br. J. Obstet. Gynaecol. 1992; 99: 79–80.Google Scholar

Brian, J. E. Jr., Boyles, G. D., Quirk, J. G. Jr.et al. Anaesthetic management for cesarean section of a patient with Charcot-Marie-Tooth Disease. Anesthesiology 1987; 66: 410–12.Google Scholar

Sawicka, E. H., Spencer, G. T. & Branthwaite, M. A.Management of respiratory failure complicating pregnancy in severe kyphoscoliosis: a new use for an old technique?Br. J. Dis. Chest 1986; 80: 191–6.Google Scholar

Antognini, J. F.Anaesthesia for Charcot-Marie-Tooth disease: a review of 86 cases. Can. J. Anaesth. 1992; 39: 398–400.Google Scholar

Reah, G., Lyons, G. R. & Wilson, R. C.Anaesthesia for caesarean section in a patient with Charcot-Marie-Tooth disease. Anaesthesia 1998; 53: 586–8.Google Scholar

Patrick, J. A., Meyer-Whiting, M., Reynolds, F. & Spencer, G. T.Perioperative care in restrictive respiratory disease. Anaesthesia 1990; 45: 390–5.Google Scholar

Scull, T.Epidural analgesia for labour in a patient with Charcot-Marie-Tooth disease. Can. J. Anaesth. 1996; 43: 1150–2.Google Scholar

Hahn, A. F., Brown, W. F., Koopman, W. J. & Feasby, T. E.X-linked dominant motor and sensory neuropathy. Brain 1990; 113: 1511–25.Google Scholar

Viet, H. R.Refsum disease. N. Engl. J. Med. 1947; 236: 996.Google Scholar

Lepski, G. R. & Alderson, J. D.Epidural analgesia in labour for a patient with hereditary neuropathy with liability to pressure palsy. Int. J. Obstet. Anesth. 2001; 10: 198–201.Google Scholar

Peters, G. & Hinds, N. P.Inherited neuropathy can cause postpartum foot drop. Anesth. Analg. 2005; 100: 547–8.Google Scholar

Sweeney, B. P., Jones, S. & Langford, R. M.Anaesthesia in dysautonomia: further complications. Anaesthesia 1985; 40: 783–6.Google Scholar

Porges, R. F., Axelrod, F. B. & Richards, M.Pregnancy in familial dysautonomia. Am. J. Obstet. Gynecol. 1978; 132: 485–8.Google Scholar

Robertson, D., Haile, V., Perry, S. E.et al. Dopamine beta-hydroxylase deficiency. A genetic disorder of cardiovascular regulation. Hypertension 1991; 18: 1–8.Google Scholar

Scurrah, N. J., Ross, A. W. & Solly, M.Peripartum management of a patient with dopamine beta-hydroxylase deficiency, a rare congenital cause of dysautonomia. Anaesth. Intens. Care 2002; 30: 484–6.Google Scholar

Dell'oste, C., Vincenti, E. & Torre, G.Multiple and various anaesthetics, ketamine included, in a young patient with familial dysautonomia: case report. Minerva Pediatrica 1996; 48: 113–16.Google Scholar

Challands, J. F. & Facer, E. K.Epidural anaesthesia and familial dysautonomia (the Riley Day syndrome). Three case reports. Paed. Anaesth. 1998; 8: 83–8.Google Scholar

Lieberman, J. R., Cohen, A., Wiznitzer, A., Maayan, C. & Greemberg, L.Cesarean section by local anesthesia in patients with familial dysautonomia. Am. J. Obstet. Gynecol. 1991; 165: 110–11.Google Scholar

Hirsch, N. P., Murphy, A. & Radcliffe, J. J.Neurofibromatosis: clinical presentation and anaesthetic implications. Br. J. Anaesth. 2001; 86: 555–64.Google Scholar

Huson, S. M.What level of care for the neurofibromatoses?Lancet 1999; 353: 1114–16.Google Scholar

Sakai, T., Vallejo, M. C. & Shannon, K. T.A parturient with neurofibromatosis type 2: anesthetic and obstetric considerations for delivery. Int. J. Obstet. Anesth. 2005; 14: 332–5.Google Scholar

Dounas, M., Mercier, F. J., Lhuissier, C. & Benhamou, D.Epidural analgesia for labour in a parturient with neurofibromatosis. Can. J. Anaesth. 1995; 42: 420–2.Google Scholar

Spiegel, J. E., Hapgood, A. & Hess, P. E.Epidural anesthesia in a parturient with neurofibromatosis type 2 undergoing cesarean section. Int. J. Obstet. Anesth. 2005; 14: 336–9.Google Scholar

www.emedicine.com/EMERG/topic222.htm

Hughes, R. A., Hadden, R. D., Gregson, N. A. & Smith, K. J.Pathogenesis of Guillain-Barré syndrome. J. Neuroimmunol. 1999; 100: 74–97.Google Scholar

Hadden, R. D., Karch, H., Hartung, H. P.et al. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Preceding infections, immune factors, and outcome in Guillain-Barré syndrome. Neurology 2001; 56: 758–65.Google Scholar

Hurley, T. J., Brunson, A. D., Archer, R. L.et al. Landry-Guillain-Barré-Strohl syndrome in pregnancy: report of three cases treated with plasmapheresis. Obstet. Gynecol. 1991; 78: 482–5.Google Scholar

Zeeman, G. G.A case of acute inflammatory demyelating polyradiculoneuropathy in early pregnancy. Am. J. Perinatol. 2001; 18: 213–15.Google Scholar

Vassiliev, D. V., Nystrom, E. U. M. & Leicht, C. H.Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barré syndrome. Reg. Anesth. Pain Med. 2001; 26: 174–6.Google Scholar

Brooks, H., Christian, A. S. & May, A. E.Pregnancy, anaesthesia and Guillain-Barré syndrome. Anaesthesia 2000; 55: 894–8.Google Scholar

Meche, F. G. & Schmitz, P. I.Dutch Guillain-Barré Study Group. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. N. Engl. J. Med. 1992; 326: 1123–9.Google Scholar

Guillain-Barré Syndrome Steroid Trial Group. Double-blind trial of intravenous methylprednisolone in Guillain-Barré syndrome. Lancet 1993; 341: 586–90.

Yamada, H., Noro, N., Kato, E. H.et al. Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain-Barré syndrome. Eur. J. Obstet. Gynecol. Reprod. Biol. 2001; 97: 101–4.Google Scholar

Wiertlewski, S., Magot, A., Drapier, S., Malinovsky, J-M. & Pereon, Y.Worsening of neurologic symptoms after epidural anesthesia for labor in a Guillain-Barré patient. Anesth. Analg. 2004; 98: 825–7.Google Scholar

McGrady, E. M.Management of labour and delivery in a patient with Guillain-Barré syndrome. (letter) Anaesthesia 1987; 42: 899.Google Scholar

Alici, H. A., Cesur, M. & Erdem, A. F.Repeated use of epidural anaesthesia for caesarean delivery in a patient with Guillain-Barré syndrome. Int. J. Obstet. Anesth. 2005: 14: 269–70.Google Scholar

Hall, J. K. & Straka, P. F.Successful epidural analgesia in a primigravida after recovery from Guillain-Barré syndrome. Reg. Anesth. 1988; 13: 129.Google Scholar

McCombe, P. A., McManis, P. G., Frith, J. A.et al. Chronic inflammatory demyelinating polyradiculoneuropathy associated with pregnancy. Ann. Neurol. 1987; 21: 102.Google Scholar

Dorsey, D. L. & Camann, W. R.Obstetric anesthesia in patients with idiopathic facial paralysis (Bell's palsy): a 10-year survey. Anesth. Analg. 1993; 77: 81–3.Google Scholar

Donaldson, J. O.Neurology of Pregnancy, 2nd edn., Philadelphia, PA: W. B. Saunders, 1989.

Farrar, D. & Raoof, N.Bell's palsy, childbirth and epidural analgesia. Int. J. Obstet. Anesth. 2001; 10: 68–70.Google Scholar

Collier, C. B.Bilateral trigeminal nerve palsy during extensive lumbar epidural block. Int. J. Obstet. Anesth. 1997; 6: 185–9.Google Scholar

Sprung, J., Haddox, D. & Maitra-D'Cruze, A. M.Horner's syndrome and trigeminal nerve palsy following epidural anaesthesia in obstetrics. Can. J. Anaesth. 1991; 38: 767–71.Google Scholar

Carrero, E. J., Agusti, M., Fabregas, N.et al. Unilateral trigeminal and facial nerve palsies associated with epidural analgesia in labour. Can. J. Anaesth. 1998; 45: 893–7.Google Scholar

Martin-Hirsch, D. P. & Martin-Hirsch, P. L.Vestibulocochlear dysfunction following epidural anaesthesia in labour. Br. J. Clin. Pract. 1994; 48: 340–1.Google Scholar

Chohan, U., Khan, M. & Saeed-uz-zafar, . Abducent nerve palsy in a parturient with a 25-gauge Sprotte needle. Int. J. Obstet. Anesth. 2003; 12: 235–6.Google Scholar

Heyman, H. J., Salem, M. R. & Klimov, I.Persistent sixth cranial nerve paresis following blood patch for postdural puncture headache. Anesth. Analg. 1982; 61: 948–9.Google Scholar

Dunbar, S. A. & Katz, N. P.Failure of delayed epidural blood patching to correct persistent cranial nerve palsies. Anesth. Analg. 1994; 79: 806–7.Google Scholar

Szokol, J. W. & Falleroni, M. J.Lack of efficacy of an epidural blood patch in treating abducent nerve palsy after an unintentional dura puncture. Reg. Anesth. Pain Med. 1999; 24: 470–2.Google Scholar

Brussé, C. A. & Burke, F. D.Recurrent anterior interosseous nerve palsies related to pregnancy. J. Hand Surg. (British and European volume) 1998; 23B: 102–3.Google Scholar

Klein, C. J., Dyck, P. J. B., Friedenberg, S. M.et al. Inflammation and neuropathic attacks in hereditary brachial plexus neuropathy. J. Neurol. Neurosurg. Psych. 2002; 73: 45–50.Google Scholar

Roubal, P. J., Chavinson, A. H. & LaGrandeur, R. M.Bilateral radial nerve palsies from use of the standard birthing chair. Obstet. Gynecol. 1996; 87: 820–1.Google Scholar

Tillman, A. J. B.Traumatic neuritis in the puerperium. Am. J. Obstet. Gynecol. 1935; 29: 660–6.Google Scholar

Chalmers, J. A.Traumatic neuritis of the puerperium. J. Obstet. Gynaecol. Br. Emp. 1949; 56: 205–16.Google Scholar

Hill, E. C.Maternal obstetric paralysis. Am. J. Obstet. Gynecol. 1962; 83: 1452–60.Google Scholar

Murray, R. R.Maternal obstetric paralysis. Am. J. Obstet. Gynecol. 1964; 88: 399–403.Google Scholar

Feasby, T. E., Burton, S. R. & Hahn, A. F.Obstetrical lumbosacral plexus injury. Muscle Nerve 1992; 15: 937–40.Google Scholar

Reynolds, F. & Bromage, P. Neurologic sequelae of childbirth and regional anesthesia. In Chestnut, D. (ed.), Obstetric Anesthesia: Principles and Practice, 3rd edn., St Louis: Mosby, 2004, pp. 579–601.

Holdcroft, A., Gibberd, F. B., Hargrove, R. L., Hawkins, D. F. & Dellaportas, C. I. Neurological problems associated with pregnancy. Br. J. Anaesth. 1995; 75: 522–6.Google Scholar

Ong, B. Y., Cohen, M. M., Esmail, A.et al. Paresthesias and motor dysfunction after labor and delivery. Anesth. Analg. 1987; 66: 18–22.Google Scholar

Dar, A. Q., Robinson, A. P. C. & Lyons, G.Postpartum neurological symptoms following regional blockade: a prospective study with case controls. Int. J. Obstet. Anesth. 2002; 11: 85–90.Google Scholar

Wong, C. A., Scavone, B. M., Dugan, S.et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet. Gynecol. 2003; 101: 279–88.Google Scholar

Holloway, J., Seed, P. T., O'Sullivan, G. & Reynolds, F.Paraesthesiae and nerve damage following combined spinal–epidural and spinal anaesthesia. Int. J. Obstet. Anesth. 2000; 9: 151–5.Google Scholar

Cohen, D. E., Duker, B., Siegel, S. & Keon, T. P.Common peroneal nerve palsy associated with epidural analgesia. Anesth. Analg. 1993; 76: 429–31.Google Scholar

Silva, M., Mallinson, C. & Reynolds, F.Sciatic nerve palsy following childbirth. Anaesthesia 1996; 51: 1144–8.Google Scholar

Kahn, L.Neuropathies masquerading as an epidural complication. Can. J. Anaesth. 1997; 44: 313–16.Google Scholar

Bademosi, O., Osuntokun, B. O., Werd, J. H.et al. Obstetric neuropraxia in the Nigerian African. Int. J. Gynaecol. Obstet. 1980; 17: 611–14.Google Scholar

Warner, M. A., Warner, D. O., Harper, M., Schroeder, D. R. & Maxson, P. M.Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93: 938–42.Google Scholar

Gherman, R., Ouzounian, J. G., Incerpi, M. H. & Goodwin, T. M.Symphyseal separation and transient femoral neuropathy associated with the McRoberts maneuver. Am. J. Obstet. Gynecol. 1998; 178: 609–10.Google Scholar

Diver, T. & Camann, W.Meralgia paresthetica in the parturient. Int. J. Obstet. Anesth. 1995; 4: 109–12.Google Scholar

Umo-Etuk, J. & Yentis, S. M.Sciatic nerve injury and caesarean section (letter). Anaesthesia 1997; 52: 605–6.Google Scholar

Roy, S., Levine, A. B., Herbison, G. J. & Jacobs, S. R.Intraoperative positioning during cesarean as a cause of sciatic neuropathy. Obstet. Gynecol. 2002; 99: 652–3.Google Scholar

Babayev, M., Bodack, M. P. & Creatura, C.Common peroneal neuropathy secondary to squatting during childbirth. Obstet. Gynecol. 1998; 91: 830–2.Google Scholar

MacLeod, A. F., Smith, S. A., Sonksen, P. H. & Lowy, C.The problem of autonomic neuropathy in diabetic pregnancy. Diabetic Medicine 1990; 7: 80–2.Google Scholar

Hagay, Z. & Weissman, A.Management of diabetic pregnancy complicated by coronary artery disease and neuropathy. Obstet. Gynecol. Clin. N. America 1996; 23: 205–20.Google Scholar

Page, M. M. & Watkins, P. J.Diabetic autonomic neuropathy. Lancet 1987; i (8054): 14–16.Google Scholar

Lapolla, A., Cardone, C., Negrin, P.et al. Pregnancy does not induce or worsen retinal and peripheral nerve dysfunction in insulin-dependent diabetic women. J. Diabetes and its Complications 1998; 12: 74–80.Google Scholar

Brodie, M. J., Moore, M. R., Thompson, G. G.et al. Pregnancy and the acute porphyrias. Br. J. Obstet. Gynaecol. 1977; 84: 726–31.Google Scholar

Bancroft, G. H. & Lauria, J. I.Ketamine induction for cesarean section in a patient with acute intermittent porphyria and achondroplastic dwarfism. Anesthesiology 1983; 59: 143–4.Google Scholar

Hempenstall, K. & Holland, R.Regional anaesthesia for emergency caesarean section in a patient with lepromatous leprosy. Anaesth. Intens. Care 1997; 25: 168–70.Google Scholar

Duncan, M. E.Pregnancy and leprosy neuropathy. Ind. J. Leprosy 1996; 68: 23–34.Google Scholar

Simpson, D. M. & Olney, R. K.Peripheral neuropathies associated with human immunodeficiency virus infection. Neurol. Clin. 1992; 10: 685–711.Google Scholar

Kissel, J. T. & Mendell, J. R. Vasculitic neuropathy. Neurol. Clin. 1992; 10: 761–81.Google Scholar

Ramsey-Goldman, R.The effect of pregnancy on the vasculitides. Scand. J. Rheumatol. 1998; 107: 116–17.Google Scholar

Regt, Haynes R.Sarcoidosis and pregnancy. Obstet. Gynecol. 1987; 70: 369–72.Google Scholar

Cohen, R., Talwar, A. & Efferen, L. S.Exacerbation of underlying respiratory disease in pregnancy. Crit. Care Clin. 2004; 20: 713–30.Google Scholar

Klaassen, D. Heavy metals and heavy-metal antagonists. In Hardman, J. G. & Limbird, L. E. (eds.), Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th edn., New York, NY: McGraw-Hill, 1996, p. 1649.

Graef, J. W. Heavy metal poisoning. In Isselbacher, K. J., Braunwald, E., Wilson, J. D.et al. (eds.), Harrison's Principles of Internal Medicine, 13th edn., New York, NY: McGraw-Hill Inc, 1994, p. 2461.

Sowers, M., Jannausch, M., Scholl, T.et al. Blood lead concentrations and pregnancy outcomes. Arch. Environ. Health 2002; 57: 489–95.Google Scholar

Centers for Disease Control and Prevention (CDC). Blood mercury levels in young children and childbearing-aged women – United States, 1999–2002. MMWR Morb. Mortal. Wkly. Rep. 2004; 53: 1018–20.

Charness, M. E., Simon, R. P. & Greenberg, D. A.Ethanol and the nervous system. N. Engl. J. Med. 1989; 321: 442–54.Google Scholar

Reynolds, F.Maximum recommended doses of local anesthetics: a constant cause of confusion. Reg. Anesth. Pain Med. 2005; 30: 314–16.Google Scholar

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