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Article

Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

by
Daniel Spitzer
1,2,
Katharina J. Wenger
3,
Vanessa Neef
4,
Iris Divé
2,5,6,7,8,
Martin A. Schaller-Paule
2,
Kolja Jahnke
2,
Christian Kell
2,
Christian Foerch
2 and
Michael C. Burger
2,5,6,7,8,*
1
Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
2
Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
3
Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
4
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany
5
Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany
6
University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany
7
Frankfurt Cancer Institute (FCI), 60596 Frankfurt, Germany
8
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, 60590 Frankfurt, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(5), 1013; https://doi.org/10.3390/jcm10051013
Submission received: 13 January 2021 / Revised: 11 February 2021 / Accepted: 24 February 2021 / Published: 2 March 2021
(This article belongs to the Section Clinical Neurology)
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Abstract

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.
Keywords: interscalene brachial plexus block; local anesthetic; CNS toxicity; toxic hemisphere syndrome; neurological outcome interscalene brachial plexus block; local anesthetic; CNS toxicity; toxic hemisphere syndrome; neurological outcome

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MDPI and ACS Style

Spitzer, D.; Wenger, K.J.; Neef, V.; Divé, I.; Schaller-Paule, M.A.; Jahnke, K.; Kell, C.; Foerch, C.; Burger, M.C. Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients. J. Clin. Med. 2021, 10, 1013. https://doi.org/10.3390/jcm10051013

AMA Style

Spitzer D, Wenger KJ, Neef V, Divé I, Schaller-Paule MA, Jahnke K, Kell C, Foerch C, Burger MC. Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients. Journal of Clinical Medicine. 2021; 10(5):1013. https://doi.org/10.3390/jcm10051013

Chicago/Turabian Style

Spitzer, Daniel, Katharina J. Wenger, Vanessa Neef, Iris Divé, Martin A. Schaller-Paule, Kolja Jahnke, Christian Kell, Christian Foerch, and Michael C. Burger. 2021. "Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients" Journal of Clinical Medicine 10, no. 5: 1013. https://doi.org/10.3390/jcm10051013

APA Style

Spitzer, D., Wenger, K. J., Neef, V., Divé, I., Schaller-Paule, M. A., Jahnke, K., Kell, C., Foerch, C., & Burger, M. C. (2021). Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients. Journal of Clinical Medicine, 10(5), 1013. https://doi.org/10.3390/jcm10051013

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