Peroneal nerve palsy due to compartment syndrome after facial plastic surgery

Foot drop secondary to rhabdomyolysis: improved foot dorsiflexion and gait after neurolysis and distal nerve transfer-a case series and literature review

Rhabdomyolysis is a triad syndrome of myalgia, muscle weakness and myoglobinuria due to muscle necrosis. Trauma, exertions, strenuous exercise, infections, metabolic and electrolyte disorders, drug overdoses, toxins and genetic defects are the most common causes of rhabdomyolysis. The etiologies of foot drop are diverse. A few cases of rhabdomyolysis-associated foot drop are reported in the literature. We present five patients with foot drop secondary to rhabdomyolysis; two underwent neurolysis and distal nerve transfer (superficial peroneal nerve to the deep peroneal nerve) surgeries and follow-up evaluations. We found five-foot drop patients secondary to rhabdomyolysis among the 1022-foot drop patients who consulted our clinic since 2004, representing a 0.5% incidence. In two patients, rhabdomyolysis was caused by drug overdose and abuse. In the other three patients, the causes were an assault with a hip injury, a prolonged hospitalization due to multiple illnesses, and an unknown cause with compartment syndrome. Pre-operatively, a 35-year-old male patient had aspiration pneumonia, rhabdomyolysis and foot drop resulting from prolonged ICU hospitalization and a medically induced coma due to a drug overdose. The second patient (a 48-year-old male) had no history of trauma but had a sudden onset of right foot drop after compartment syndrome following the insidious onset of rhabdomyolysis. Both patients had difficulty dorsiflexing their involved foot and walked with a steppage gait before surgery. In addition, the 48-year-old patient had foot slapping while walking. However, both patients had strong plantar flexion (5/5). After 14 and 17 months of surgery, both patients had improved foot dorsiflexion to an MRC grade of 4/5 with an improved gait cycle and walked with no or minimal slapping, respectively. Distal motor nerve transfers in the lower limb facilitate faster recovery and less surgical dissection because of the shorter regeneration distance from the donor axons to the targeted motor end plates through residual neural network connections and descending motor signals.

Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs

Non-traumatic acute bilateral compartment syndrome is a rare condition that may lead to limb ischemia. We describe a case of this syndrome occurring after a five-kilometer walk in a young woman receiving chronic treatment with lurasidone, leading to a bilateral foot-drop and rhabdomyolysis of the anterolateral compartment of both legs. Due to her late presentation in the emergency department, we opted for a conservative approach, closely monitoring her renal function. We noticed a subsequent clinical and biochemical improvement over the following days, with the patient returning to her daily routine in a matter of weeks, despite a persisting bilateral foot drop. Since atypical antipsychotics are known to be associated with rhabdomyolysis, while possibly exerting a toxic effect on mitochondria, we hypothesize that a mild aerobic physical exertion might have triggered the event, in the context of an iatrogenic muscle susceptibility to oxidative distress.

Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature

Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health. A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included. In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy. This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.

Well leg compartment syndrome postorthognathic surgery under hypotensive anesthesia and reverse Trendelenburg position: a case report and literature review

INTRODUCTION

Well leg compartment syndrome is a rare postoperative condition that occurs as a result of non-traumatic ischemic insult. It has similar pathophysiology to compartment syndrome; however, no definitive etiology is identified. Several risk factors such as patient position, leg position, young age, and high BMI for the development of this condition are considered.

CASE REPORT

A 30 years old male smoker and overweight, underwent mandibular and maxillary osteotomies in reverse Trendelenburg position. He developed a WLCS post-operative and treated with fasciotomy.

CONCLUSION

Increased Awareness of this rare occurrence and predisposition aids in understanding and prompt management. This article provides a rare case that has occurred in reverse Trendelenburg position with less obvious risk factors than typically reported in the literature.

Sonographic evaluation of peripheral nerve injuries following the Wenchuan earthquake

PURPOSE

To analyze retrospectively the sonographic characteristics of the peripheral nerve injuries (PNIs) resulted from Wunchuan earthquake.

METHODS

The sonographic images of 38 patients with surgically proved PNIs were reviewed and compared with the surgical findings.

RESULTS

A total of 78 nerves in 38 patients were found injured in surgery, which included 16 median nerves in the forearm (20.5%), 6 ulnar nerves in the forearm or arm (7.7%), 8 radial nerves in upper limb (10.0%), 8 sciatic nerves (10.3%) in gluteal region, 17 tibial nerves in the leg (21.8%), and 23 peroneal nerves (29.5%). The most common injured nerve in the lower extremity was the peroneal nerve (29.5%) and in upper extremity was the median nerve (20.5%). Sonography correctly diagnosed 72 earthquake-related nerve injuries (92.3%), which included 5 complete disruption (6.4%), 4 partial disruption (5.1%), 63 nerve entrapment (88.5%, included 1 entrapment by bone calus, 38 entrapments by the scar tissue, 13 entrapments by the thickened muscle or tendinous arch, and 11 entrapment in the narrowed osteofibrous tunnels).

CONCLUSIONS

Nerve entrapment injury was the common sonographic finding in earthquake-related PNI.