Median Nerve Mononeuropathy and Meralgia Paresthetica After Prone Positioning in a Patient with COVID-19 ARDS

Ravella, Krishna C.; Redondo, Michael L.; Mejía, Alfonso; Gonzalez, Mark H.

doi:10.2106/jbjs.cc.21.00260

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Case reports of meralgia paresthetica have been documented in covid patients most likely due to prone positioning. 13,14 Similarly, nine patients presented with myalgia, and all of them within the medium-term period, suggesting a post-infectious etiology. Myalgia and fatigue are proposed to be due to an underlying myopathy.…”

Section: Discussionmentioning

confidence: 98%

Short, medium and long term neurological manifestations and outcome in Covid-19 Patients

Hameed

Soomro

Iltaf

et al. 2023

PJNS

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Background and objectives: There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients. Methods: This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (< 1 month), medium-term (2-3 months) and long-term (>4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Results: Neurological manifestations were reported in 208 out of 905 covid patients. One-hundred-twenty-five (60%) developed neurological manifestations within one month, 62 (30%) developed within 2-3 months and 21 (10%) developed between 4-6 months. Most common manifestations within one month included cerebrovascular disease (59%), neuromuscular disorders (14%) and neuropsychiatric disorders (10%). Common manifestations in 2-3 months group included neuromuscular manifestations (32%), neuropsychiatric manifestations (19%), cerebrovascular diseases (14 %), myalgia or musculoskeletal pain (14%), and vertigo, hearing problems or tinnitus (14%). Common manifestations in 4-6 months group included neuromuscular disorders (33%) cerebrovascular diseases (19%), fatigue / malaise (9%) anosmia/dysgeusia (9%) and Bell’s palsy (25%). The long-term patients differed from the short-term patients by a mean younger age on presentation (44.7 vs. 59 years), female predominance (52% vs. 28%), higher asymptomatic Covid infection (29% vs. 14%), better clinical outcomes (mean mRS of 1.6 vs. 3), and low mortality (0 vs 18%). Conclusion: Neurological manifestations of covid infection may differ based on time duration since infection. Vascular complications are high in early period while neuromuscular manifestations are high in late period.

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Section: Discussionmentioning

confidence: 98%

Short, medium and long term neurological manifestations and outcome in Covid-19 Patients

Hameed

Soomro

Iltaf

et al. 2023

PJNS

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“… 45 The authors assume MP to be an underdiagnosed condition in patients who receive mechanical ventilation in PP. 56 , 63 , 74 …”

Section: Evidence Synthesismentioning

confidence: 99%

Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Elmer¹,

Reißhauer²,

Brehm³

et al. 2023

Eur J Phys Rehabil Med

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INTRODUCTION Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions ( i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.

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“…Die MP kann sich jedoch auch, wie u. a. die hier vorgestellten 6 Fälle zeigen, postoperativ als Lagerungsschaden oder aber, wie in letzter Zeit zunehmend publiziert [ 3 , 4 , 15 , 25 , 35 ], als Folge von Lagerungsmaßnahmen im Zusammenhang mit einer intensivmedizinischen Behandlung verwirklichen. In der Literatur hat diese Pathologie bisher geringe Aufmerksamkeit gefunden.…”

Section: Diskussionunclassified

Meralgia paraesthetica als Lagerungsschaden

2022

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Als Meralgia paraesthetica (MP) bezeichnet man eine zu den neurologischen Engpasssyndromen zählende Schädigung des aus dem Plexus lumbalis entspringenden sensiblen N. cutaneus femoris lateralis. Symptome sind temporäre oder bleibende Parästhesien und Schmerzen an der Vorder- und Außenseite des Oberschenkels. Die MP kann idiopathisch auftreten, sich genuin als z. B. „seat belt syndrome“ oder „Jeans-Syndrom“ verwirklichen, sie kann aber auch Folge eines operativen Eingriffs oder einer chirurgischen bzw. intensivmedizinischen Lagerung sein. Im Fokus stehen hierbei in der Literatur die Steinschnitt-, die Bauch- und die „Beach-chair“-Lagerung. Analysiert wurden 21 Beschwerden über eine postoperativ erstmals aufgetretene MP, die bei der Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein im Verlauf der letzten 10 Jahre eingereicht wurden. Unter diesen konnten 6 Fälle als Lagerungsschaden nach Steinschnittlagerung identifiziert werden; in 3 Fällen trat eine MP nach Rückenlagerung auf; die Ätiologie konnte nicht sicher geklärt werden. In 12 Fällen wurde die MP als direkte Operationskomplikation erkannt. Pathophysiologie, Inzidenz und Verlauf sowie juristische Implikationen der lagerungsbedingten MP werden beschrieben. Als hauptsächlicher Pathomechanismus wird eine Druckschädigung des Nervs an seiner Kreuzungsstelle mit dem Leistenband diskutiert. Wenngleich alle hier vorgestellten Fälle nach der Steinschnittlagerung auftraten, scheint sich die Komplikation nach Literaturdaten auch bei anderen Lagerungsarten, am häufigsten möglicherweise bei Bauchlagerungen, zu verwirklichen. Dies erklärt auch die zunehmenden Fallberichte einer MP nach Bauchlagerung bei COVID-19-Patient*innen. Eine sichere Vermeidung der lagerungsbedingten Komplikation erscheint aufgrund der anatomischen Variabilität des Nervenverlaufs und der unklaren Pathomechanismen nicht möglich.

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Median Nerve Mononeuropathy and Meralgia Paresthetica After Prone Positioning in a Patient with COVID-19 ARDS

Cited by 3 publications

References 15 publications

Short, medium and long term neurological manifestations and outcome in Covid-19 Patients

Short, medium and long term neurological manifestations and outcome in Covid-19 Patients

Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Meralgia paraesthetica als Lagerungsschaden

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