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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 19 octobre 2018
Doi : 10.1016/j.accpm.2018.07.008
Cranial nerves VII and XII palsy after shoulder surgery
 

Thierry Garnaud a, , Marmoud Muheish b, Muriel Cholot b, Thibaut Austruy b
a Anaesthesiology department, Rodez general hospital, avenue de l'Hôpital, 12000 Rodez, France 
b Radiology department, Rodez general hospital, avenue de l'Hôpital, 12000 Rodez, France 

Corresponding author.
Abstract

A 46-year-old man underwent a left shoulder surgery in the beach chair position with general anaesthesia and oro-tracheal intubation preceded by a left interscalenic block. Patient's head was attached to the headrest in a position of soft extension and moderate right rotation with adhesive tape surrounding his forehead and mandible. Surgery was marked by repeated vertical tractions on the left arm and by blood resorption of the arthroscopy's irrigation fluid, including epinephrine, which translated in a heart rate and arterial blood pressure rise. Upon waking the patient had severe headaches, left Horner's sign, left facial paresis and a left lingual paralysis. MRI and CT scan did not show any carotid dissection or parapharyngeal lesion. Electromyogram and neurological examination confirmed a VII and XII cranial nerve peripheral lesion, which took several months to regress. An ischaemic complication was suspected although the most probable cause of the patient's symptoms was subsequent to an Eagle's syndrome neurapraxia related to a long styloid process.

The full text of this article is available in PDF format.

Keywords : Beach chair position, Eagle's syndrome, Palsy, Hypoglossal nerve, Facial nerve, Shoulder surgery




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