Transient Bilateral Ophthalmoplegia: A Case of a Forgotten Anesthetic Medication Effect

Abstract

A 58-year-old woman was found to have bilateral ptosis and downward gaze deviation immediately after elective shoulder surgery with general anesthesia and supraclavicular nerve block. A code stroke was activated due to concern for the neurologic process, but neuroimaging did not reveal acute changes or vascular abnormality. Her symptoms gradually resolved in the following hours with supportive care and were ultimately deemed to be related to anesthetic and transdermal scopolamine exposures layered upon her underlying comorbidities. Transient bilateral ophthalmoplegia after general anesthetics has been previously described; drug effect should be considered in the differential of this alarming presentation, which can mimic acute stroke and/or Horner syndrome.

Stroke mimics: A review

“…Toxicity of some other medications such as 5-Fluorouracil [87], anesthetic and transdermal scopolamine exposures [88,89], and acetazolamide may mimic stroke according the published literatures [90]. Bismuth-related acute neurotoxicity can lead to SMs as well as toxicity of Stramonium, tetrahydrocannabinol edible ingestion, abuse of nitrous oxide and so forth [91][92][93][94].…”