The cause of post surgical neuropathy
What could be the cause of post surgical neuropathy? In the September 2010 online issue of Brain, the father of neuropathies, P. James Dyck, MD, and colleagues from the Mayo Clinic in Rochester, Minnesota discussed the origin (cause) of post surgical neuropathies.
- “These neuropathies may be caused by inflammation. It is important for physician to recognize that not all neuropathies that occur in the post surgical setting, are due to mechanical factors. Such as compression, transaction or stretching of nerves during surgery.”
In 23 patients with unexplained post surgical neuropathies, nerve biopsies showed increased inflammation in most patients, as well as ischemic nerve injury.
In all 21 cases of biopsy-confirmed post surgical inflammatory neuropathy, neuropathies developed within 30 days of a surgical procedure.
The neuropathies were focal in 6 patients, multifocal in 11, and diffuse in 4.
Dyck et al stated:
- “If a neuropathy occurs after a delay or in a territory remote from the surgical site, an inflammatory-immune mechanism should be considered,” and “Focally increased T2 nerve signal and enlargement within nerve segments on MRI sometimes provided another clue to the inflammatory etiology,”
Electrophysiologic testing showed axonal damage in nearly all cases.
Treatment of post surgical neuropathies
Of the 21 patients with biopsy-confirmed post surgical inflammatory neuropathy, 17 were treated with immune therapy. Fifteen received intravenous methyl prednisolone (12 weekly doses of 1 g). 1 received oral steroids, and 1 received intravenous immunoglobulin. The median neuropathy impairment score improved significantly from 30 at the initial evaluation to 24 at last follow-up.
Pain improved first and weakness followed.
Although it is unclear what the true incidence of post surgical inflammatory neuropathy is, the authors think it is relatively common, but under recognized.
Based on their findings inflammation seems an important mechanism of nerve injury in post surgical cases. Specific insight in who to treat and who will respond is still unclear.
October 2010, Jan M. Keppel Hesselink, MD, PhD
‘The cause of post surgical neuropathies’