A Rare Case of Vincristine-Induced Neuropathy Presenting as Foot Drop in the Postoperative Period.

Abstract

Patients with cancer receiving chemotherapy are at risk of neuropathy development. Many of them may have subclinical neuropathies, which may be missed before planning anesthesia, especially in emergency scenarios. This case report highlights the importance of a thorough neurologic examination in patients with subclinical neuropathy to avoid any complications and medicolegal issues. A patient with a diagnosis of diffuse large B-cell lymphoma being treated with vincristine-based chemotherapy was scheduled for an emergency laparotomy. There was no history of any neurologic deficit before surgery. The surgery was done using general anesthesia, and intrathecal morphine was given for postoperative analgesia. This patient experienced bilateral foot drop postoperatively. A bilateral lower limb and upper limb sensory-motor neuropathy was detected on a nerve conduction study, probably due to vincristine-induced peripheral neuropathy. The literature is deficient regarding manifestations of neurologic complications in previously asymptomatic patients in the immediate postoperative period. These patients pose a diagnostic dilemma perioperatively that may lead to medicolegal challenges to the anesthesia provider. Anesthesia providers should be wary of the possibility of exacerbation of any subclinical neuropathy in patients with cancer receiving neurotoxic chemotherapy and should probably avoid any neuraxial intervention in such patients if possible.

• Authors: Nishkarsh Gupta, Saurabh Vig, Swati Bhan, Sachidanand Jee Bharati, Seema Mishra
• Journal: AANA journal (AANA J) Vol. 88 Issue 4 Pg. 299-302 (Aug 2020) ISSN: 2162-5239 [Electronic] United States
• PMID: 32718427 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © by the American Association of Nurse Anesthetists.

Chemical References

• Antineoplastic Agents
• Vincristine

Topics

• Aged
• Antineoplastic Agents (adverse effects)
• Diagnosis, Differential
• Gastrointestinal Neoplasms (complications, drug therapy)
• Humans
• Laparoscopy
• Lymphoma, Large B-Cell, Diffuse (complications, drug therapy)
• Male
• Neurologic Examination
• Nurse Anesthetists
• Peroneal Neuropathies (chemically induced, diagnosis)
• Postoperative Complications (chemically induced, diagnosis)
• Stomach Ulcer (complications, surgery)
• Vincristine (adverse effects)