Acute perioperative neurological emergencies

Abstract

Perioperative neurological complications can be a result of anesthesia or surgical procedures. Both surgery and anesthesia increases the risk of neurological sequelae due to ischemia, hemorrhage, hypoxia, or metabolic disorder (Table 1). [1][2][3][4][5][6][7][8][9][10] The impact can be devastating, leading to morbidity, increased length of stay, impaired quality of life, and mortality. [11][12][13] During anesthesia, there is no standard monitoring for the neurological system compared with other organs (eg, electrocardiograph and blood pressure for the cardiovascular system, pulse oximetry, and capnography for the respiratory system). When patients present with neurological signs and symptoms perioperatively, early assessment and imaging is needed to facilitate prompt diagnosis and management.This article will provide an overview of common neurological complications in the perioperative period. To cover details of all neurological emergencies will be beyond the scope of this article. We will focus on common emergencies in general surgery with a brief discussion of neurological complications in specific surgical populations. The common presentation of these complications will be explored, followed by the diagnosis and management of these pathologies. Presentation of neurological emergencies Focal neurological deficitNeurological deficit can be caused by injury to the brain, spinal cord, or peripheral nerves. Careful neurological examination and interpretation with clinical context is needed to identify the possible site of injury and arrive at the correct diagnosis. Common causes of neurological deficit with corresponding physical findings is summarized in Table 2.