TY  - JOUR
A1  - Spitzer, Daniel
A1  - Wenger-Alakmeh, Katharina Johanna
A1  - Neef, Vanessa
A1  - Divé, Iris
A1  - Schaller-Paule, Martin A.
A1  - Jahnke, Kolja
A1  - Kell, Christian
A1  - Förch, Christian
A1  - Burger, Michael Christian
T1  - Local anesthetic-induced central nervous system toxicity during interscalene brachial plexus block: a case series study of three patients
T2  - Journal of Clinical Medicine
N2  - 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.
KW  - interscalene brachial plexus block
KW  - local anesthetic
KW  - CNS toxicity
KW  - toxic hemisphere syndrome
KW  - neurological outcome
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62477
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-624772
SN  - 2077-0383
VL  - 10
IS  - 5, art. 1013
SP  - 1
EP  - 13
PB  - MDPI
CY  - Basel
ER  -