约束带继发的肢体缩窄性压迫神经病1例报告

Tiffany Ella Rose Say, R. Rosales
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引用次数: 0

摘要

理由:压迫性神经病是发生在特定解剖位置的周围神经紊乱。它们可能是由扭伤或骨折等外伤引起的,但通常是由于神经在狭窄的解剖空间中行进时受到反复的损伤或压迫而引起的。怀孕和先前存在的合并症,如糖尿病、肥胖、癌症或自身免疫性疾病也可能导致神经卡压。目的:报告一名52岁女性患者在住院后连续绑扎后出现右足感觉不良和无力的病例。病例:这里我们有一个52岁的菲律宾女性就诊,因为右脚感觉不良,异常性疼痛,和轻度无力。患者有双相情感障碍病史,近期出现急性精神病,并过量服用不规律服用维持奥氮平片。在住院的一周时间里,她被绑上了右下肢的绑带。这导致右脚踝出现束缚痕,并伴有脚跟和脚趾行走困难,自发性感觉不良,整个右脚触觉异常性痛。电诊断显示右下肢局灶性神经病变,包括右腓骨神经、右胫神经、右腓骨浅神经和右腓肠神经。给予阿米替林加巴喷丁治疗6个月,神经性疼痛逐渐改善。讨论和总结:我们的病例体现了约束带夹持引起的局灶性肢体神经病变。电诊断确认同一肢体感觉神经和运动神经的神经病变是为了证实临床神经性疼痛,并在排除其他原因的卡压性神经病变后。在本病例中,需要长期使用神经性疼痛药物来获得缓解。限制性绑带是一种医源性的神经病变,是可以预防的,如果有适当的医疗注意应用。
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Constrictive Entrapment Neuropathies of a Limb Secondary to Restraint Strapping: A Case Report
Rationale: Entrapment neuropathies are peripheral nerve disorders at specific anatomical locations. They may be caused by trauma in a manner of sprains or bone fracture, but it is often caused by repetitive insults or compression of nerves as they travel through a narrow anatomic space. Pregnancy and pre-existing comorbidities such as diabetes, obesity, cancer, or autoimmune diseases may also cause nerve entrapment. Objective: To highlight the case of a 52-year-old female developing right foot dysesthesia and weakness after continuous restraint strapping from her previous hospitalization. Case: Here we have the case of a 52-year-old Filipino female consulted because of right foot dysesthesia, allodynia, and mild weakness. She had a history of bipolar disorder and recent onset of acute psychosis and overdosing with her irregularly taken maintenance olanzapine tablets. She was put on restraint strapping of the right lower limb in her one-week hospital stay. This resulted in developing restraint marks on her right ankle accompanied by difficulty walking on heels and toes, spontaneous dysesthesia, and touch allodynia of her entire right foot. An electrodiagnosis yielded right lower limb focal neuropathies involving the right fibular nerve, right tibial nerve, right superficial fibular, and right sural nerves. The prescribed amitriptyline and gabapentin for 6 months led to gradual improvement of neuropathic pain. Discussion and Summary: Our case exemplifies focal limb neuropathies from entrapment due to restraint strapping. Electrodiagnostic confirmation of neuropathies of the same limb sensory and motor nerves was mandated to corroborate clinical neuropathic pain and after ruling out other causes of entrapment neuropathies. Prolonged use of neuropathic pain medications were needed to attain relief in this present case. Restrictive strapping is an iatrogenic cause of entrapment neuropathy that is preventable, had there been proper medical attention applied.
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