Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-06-01T12:27:59.789Z Has data issue: false hasContentIssue false

Chapter 16 - Peripheral Neuropathies

Published online by Cambridge University Press:  26 January 2024

By
Cynthia A. Wong
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Grace Lim
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Grace Lim
Affiliation:
University of Pittsburgh
Get access

Summary

Peripheral neuropathy takes many forms and occurs as a primary condition or as a component of diseases with multisystem manifestations. There are manifold etiologies, including genetic, inflammatory, traumatic/compressive, metabolic, vasculitic, neoplastic, dietary, and toxic/drug-induced. They are classified as mononeuropathy, multifocal neuropathy (mononeuropathy multiplex), or polyneuropathy. Peripheral neuropathies affect the cell body and the axon (neuropathy, axonopathy) or the myelin sheath (demyelinating neuropathy/neurapraxia). Neuropathies affect sensory, motor, autonomic nerves, or a combination. Pregnancy exacerbates some neuropathies, while pregnancy or parturition may be a direct or indirect cause of a variety of mononeuropathies and plexopathies. A peripheral neuropathy does not directly impact anesthetic care but associated systemic disease manifestations can complicate peripartum anesthetic care. Some peripheral neuropathies alter drug sensitivity or impair respiration, presenting unique challenges to the anesthesiologist.

Keywords

Peripheral neuropathyCharcot-Marie-Tooth diseaseHereditary neuropathyAutonomic neuropathyDysautonomiaCompressive neuropathyObstetric palsyDiabetic neuropathy
Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 259 - 272
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Donofrio, PD. Clinical approach to the patient with peripheral neuropathy. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy: New York, NY: Demos Medical Publishing, 2012: 1–7.Google Scholar
Ropper, AH, Samuels, MA, Klein, JP, et al. Diseases of the peripheral nerves. Adams and Victor’s Principles of Neurology. London: McGraw-Hill, 2019.Google Scholar
Massey, EW, Massey, JM. Mononeuropathies in pregnancy. Handb Clin Neurol 2020;172:145–151.Google Scholar
Wong, CA. Neurologic deficits and labor analgesia. Reg Anesth Pain Med 2004;29:341–351.Google Scholar
Pareyson, D, Saveri, P, Pisciotta, C. New developments in Charcot-Marie-Tooth neuropathy and related diseases. Curr Opin Neurol 2017;30:471–480.CrossRefGoogle ScholarPubMed
Li, J. Inherited peripheral neuropathies (Charcot-Marie-Tooth disease). In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy. New York, NY: Demos Medical Publishing, 2012: 107–116.Google Scholar
McMillan, HJ, Jones, HR. Peripheral neuropathies in childhood. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy. New York, NY: Demos Medical Publishing, 2012: 339–362.Google Scholar
Hoff, JM, Gilhus, NE, Daltveit, AK. Pregnancies and deliveries in patients with Charcot-Marie-Tooth disease. Neurology 2005;64:459–462.Google Scholar
Rudnik-Schöneborn, S, Röhrig, D, Nicholson, G, et al. Pregnancy and delivery in Charcot-Marie-Tooth disease type 1. Neurology 1993;43:2011–2016.Google Scholar
Rudnik-Schöneborn, S, Thiele, S, Walter, MC, et al. Pregnancy outcome in Charcot-Marie-Tooth disease: results of the CMTD-NET cohort study in Germany. Eur J Neurol 2020;27:1390–1396.Google Scholar
Kopp, SL, Jacob, AK, Hebl, JR. Regional anesthesia in patients with preexisting neurologic disease. Reg Anesth Pain Med 2015;40:467–478.Google Scholar
Antognini, JF. Anaesthesia for Charcot-Marie-Tooth disease: a review of 86 cases. Can J Anaesth 1992;39:398–400.Google Scholar
Greenwood, JJ, Scott, WE. Charcot-Marie-Tooth disease: peripartum management of two contrasting clinical cases. Int J Obstet Anesth 2007;16:149–154.Google Scholar
Peters, G, Hinds, NP. Inherited neuropathy can cause postpartum foot drop. Anesth Analg 2005;100:547–548.Google Scholar
Surgery and HNPP. 2000. Available from: https://web.archive.org/web/20161126113558/ [last accessed October 15, 2022].Google Scholar
Lepski, GR, Alderson, JD. Epidural analgesia in labour for a patient with hereditary neuropathy with liability to pressure palsy. Int J Obstet Anesth 2001;10:198–201.Google Scholar
Samuel, K, Mead, K, Cominos, T, et al. Spinal anaesthesia for elective caesarean section in a patient with hereditary neuropathy with liability to pressure palsies. Int J Obstet Anesth 2019;40:162–163.Google Scholar
Freeman, R. Autonomic peripheral neuropathy. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy: New York, NY: Demos Medical Publishing, 2012: 421–437.Google Scholar
Bar-Aluma, BE. Familial dysautonomia. In Adam, MP, Ardinger, HH, Pagon, RA, et al. (Eds.), GeneReviews(®). Seattle (WA): University of Washington, 1993 (updated 2021).Google Scholar
Porges, RF, Axelrod, FB, Richards, M. Pregnancy in familial dysautonomia. Am J Obstet Gynecol 1978;132:485–488.Google Scholar
Ropper, AH, Samuels, MA, Klein, JP, et al. Developmental diseases of the nervous system. Adams and Victor’s Principles of Neurology. London: McGaw-Hill, 2019.Google Scholar
Terry, AR, Barker, FG, 2nd, Leffert, L, et al. Neurofibromatosis type 1 and pregnancy complications: a population-based study. Am J Obstet Gynecol 2013;209:46.e1–e8.Google Scholar
Hirsch, NP, Child, CS, Wijetilleka, SA. Paraplegia caused by spinal angioma–possible association with epidural analgesia. Anesth Analg 1985;64:937–940.Google Scholar
Dounas, M, Mercier, FJ, Lhuissier, C, et al. Epidural analgesia for labour in a parturient with neurofibromatosis. Can J Anaesth 1995;42:420–422.Google Scholar
Spiegel, JE, Hapgood, A, Hess, PE. Epidural anesthesia in a parturient with neurofibromatosis type 2 undergoing cesarean section. Int J Obstet Anesth 2005;14:336–339.Google Scholar
Pacheco, LD, Saad, AF, Hankins, GD, et al. Guillain-Barré syndrome in pregnancy. Obstet Gynecol 2016;128:1105–1110.Google Scholar
Makhluf, H, Madany H. SARS-CoV-2 infection and Guillain-Barré syndrome. Pathogens 2021;10:936.CrossRefGoogle ScholarPubMed
Wiertlewski, S, Magot, A, Drapier, S, et al. Worsening of neurologic symptoms after epidural anesthesia for labor in a Guillain-Barré patient. Anesth Analg 2004;98:825–827.Google Scholar
McGrady, EM. Management of labour and delivery in a patient with Guillain-Barré syndrome. Anaesthesia 1987;42:899.CrossRefGoogle Scholar
Alici, HA, Cesur, M, Erdem, AF, et al. Repeated use of epidural anaesthesia for caesarean delivery in a patient with Guillain-Barré syndrome. Int J Obstet Anesth 2005;14:269–270.Google Scholar
Vassiliev, DV, Nystrom, EU, Leicht, CH. Combined spinal and epidural anesthesia for labor and cesarean delivery in a patient with Guillain-Barré syndrome. Reg Anesth Pain Med 2001;26:174–176.Google Scholar
Brooks, H, Christian, AS, May, AE. Pregnancy, anaesthesia and Guillain-Barré syndrome. Anaesthesia 2000;55:894–898.Google Scholar
Kohle, F, Kuwabara, S, Lehmann, HC. Chronic inflammatory demyelinating polyneuropathy and pregnancy: systematic review. J Neurol Neurosurg Psychiatry 2021;92:473–478.Google Scholar
Farrar, D, Raoof, N. Bell’s palsy, childbirth, and epidural analgesia. Int J Obstet Anesth 2001;10:68–70.Google Scholar
Collier, CB. Trigeminal nerve palsy and Horner’s syndrome following epidural analgesia for labour: not a subdural block. Int J Obstet Anesth 2008;17:92–93.Google Scholar
Sprung, J, Haddox, JD, Maitra-D’Cruze, AM. Horner’s syndrome and trigeminal nerve palsy following epidural anaesthesia for obstetrics. Can J Anaesth 1991;38:767–771.Google Scholar
Carrero, EJ, Agustí, M, Fábregas, N, et al. Unilateral trigeminal and facial nerve palsies associated with epidural analgesia in labour. Can J Anaesth 1998;45:893–897.Google Scholar
Martin-Hirsch, DP, Martin-Hirsch, PL. Vestibulocochlear dysfunction following epidural anaesthesia in labour. Br J Clin Pract 1994;48:340–341.Google Scholar
Hofer, JE, Scavone, BM. Cranial nerve VI palsy after dural-arachnoid puncture. Anesth Analg 2015;120:644–646.Google Scholar
Chohan, U, Khan, M, Saeed, UZ. Abducent nerve palsy in a parturient with a 25-gauge Sprotte needle. Int J Obstet Anesth 2003;12:235–236.Google Scholar
Roubal, PJ, Chavinson, AH, LaGrandeur, RM. Bilateral radial nerve palsies from use of the standard birthing bar. Obstet Gynecol 1996;87:820–821.Google Scholar
Seror, P. Neuralgic amyotrophy. An update. Joint Bone Spine 2017;84:153–158.Google Scholar
Murray, RR. Maternal obstetric palsies. Am J Obstet Gynecol 1964;88:399–403.Google Scholar
Tillman, AJB. Traumatic neuritis in the puerperium. Am J Obstet Gynecol 1935;29:660–666.Google Scholar
Chalmers, JA. Traumatic neuritis of the puerperium. J Obstet Gynaecol Br Emp 1949;56:205–216.Google Scholar
Feasby, TE, Burton, SR, Hahn, AF. Obstetrical lumbosacral plexus injury. Muscle Nerve 1992;15:937–940.Google Scholar
Holdcroft, A, Gibberd, FB, Hargrove, RL, et al. Neurological complications associated with pregnancy. Br J Anaesth 1995;75:522–526.Google Scholar
Ong, BY, Cohen, MM, Esmail, A, et al. Paresthesias and motor dysfunction after labor and delivery. Anesth Analg 1987;66:18–22.Google Scholar
Dar, AQ, Robinson, APC, Lyons, G. Postpartum neurologic symptoms following regional blockade: a prospective study with case controls. Int J Obstet Anesth 2002;11:85–90.Google Scholar
Wong, CA, Scavone, BM, Dugan, S, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003;101:279–288.Google Scholar
Cohen, DE, Van Duker, B, Siegel, S, et al. Common peroneal nerve palsy associated with epidural analgesia. Anesth Analg 1993;76:429–431.Google Scholar
Kahn, L. Neuropathies masquerading as an epidural complication. Can J Anaesth 1997;44:313–316.Google Scholar
Holloway, J, Seed, PT, O’Sullivan, G, et al. Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia: a pilot survey. Int J Obstet Anesth 2000;9:151–155.Google Scholar
Warner, MA, Warner, DO, Harper, M, et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000;93:938–942.Google Scholar
Gherman, RB, Ouzounian, JG, Incerpi, MH, et al. Symphyseal separation and transient femoral neuropathy associated with the McRoberts’ maneuver. Am J Obstet Gynecol 1998;178:609–610.Google Scholar
Van Diver, T, Camann, W. Meralgia paresthetica in the parturient. Int J Obstet Anesth 1995;4:109–112.Google Scholar
Silva, M, Mallinson, C, Reynolds, F. Sciatic nerve palsy following childbirth. Anaesthesia 1996;51:1144–1148.Google Scholar
Umo-Etuk, J, Yentis, SM. Sciatic nerve injury and caesarean section [letter]. Anaesthesia 1997;52:605–606.Google Scholar
Roy, S, Levine, AB, Herbison, GJ, et al. Intraoperative positioning during cesarean as a cause of sciatic neuropathy. Obstet Gynecol 2002;99:652–653.Google ScholarPubMed
Babayev, M, Bodack, MP, Creatura, C. Common peroneal neuropathy secondary to squatting during childbirth. Obstet Gynecol 1998;91:830–832.Google Scholar
Redick, LF. Maternal perinatal nerve palsies. Postgrad Obstet Gynecol 1992;12:1–5.Google Scholar
Russell, R. Assessment of motor blockade during epidural analgesia in labour. Int J Obstet Anesth 1992;1:230–234.Google Scholar
Sviggum, H, Reynolds, F. Neurologic complications of pregnancy and neuraxial anesthesia. In Chestnut, DH, Wong, CA, Tsen, LC, et al. (Eds.), Chestnut’s Obstetric Anesthesia Principles and Practice. Philadelphia, PA: Elsevier, 2020: 752–776.Google Scholar
Carmichael, J, Fadavi, H, Ishibashi, F, et al. Advances in screening, early diagnosis, and accurate staging of diabetic neuropathy. Front Endocrinol (Lausanne) 2021;12:671257.Google Scholar
Pop-Busui, R, Boulton, AJ, Feldman, EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017;40:136–154.Google Scholar
Lapolla, A, Cardone, C, Negrin, P, et al. Pregnancy does not induce or worsen retinal and peripheral nerve dysfunction in insulin-dependent diabetic women. J Diabetes Complications 1998;12:74–80.Google Scholar
Macleod, AF, Smith, SA, Sönksen, PH, et al. The problem of autonomic neuropathy in diabetic pregnancy. Diabet Med 1990;7:80–82.Google Scholar
Gandhi, RA, Marques, JL, Selvarajah, D, et al. Painful diabetic neuropathy is associated with greater autonomic dysfunction than painless diabetic neuropathy. Diabetes Care 2010;33:1585–1590.Google Scholar
Gandhi Mehta, RK, Caress, JB, SR, et al. Porphyric neuropathy. Muscle Nerve 2021;64:140–152.Google Scholar
Farfaras, A, Zagouri, F, Zografos, G, et al. Acute intermittent porphyria in pregnancy: a common misdiagnosis. Clin Exp Obstet Gynecol 2010;37:256–260.Google Scholar
de Freitas, MRC, de Mendonca Cardoso, F. Infectious neuropathies. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy. New York, NY: Demos Medical Publishing, 2012: 259–272.Google Scholar
Ozturk, Z, Tatliparmak, A. Leprosy treatment during pregnancy and breastfeeding: a case report and brief review of literature. Dermatol Ther 2017;30:e12414.Google Scholar
Hempenstall, K, Holland, R. Regional anaesthesia for emergency caesarean section in a patient with lepromatous leprosy. Anaesth Intensive Care 1997;25:168–170.Google Scholar
Aziz-Donnelly, A, Harrison, TB. Update of HIV-associated sensory neuropathies. Curr Treat Options Neurol 2017;19:36.Google Scholar
Blaes, F. Diagnosis and therapeutic options for peripheral vasculitic neuropathy. Ther Adv Musculoskelet Dis 2015;7:45–55.Google Scholar
Machen, L, Clowse, ME. Vasculitis and pregnancy. Rheum Dis Clin North Am 2017;43:239–247.Google Scholar
Pawate, S. Sarcoidosis and the nervous system. Continuum (Minneap Minn) 2020;26:695–715.Google Scholar
Drent, M, Crouser, ED, Grunewald, J. Challenges of sarcoidosis and its management. N Engl J Med 2021;385:1018–1032.CrossRefGoogle ScholarPubMed
Freymond, N, Cottin, V, Cordier, JF. Infiltrative lung diseases in pregnancy. Clin Chest Med 2011;32:133–146.Google Scholar
Albers, JW. Occupational, biologic, and environmental toxic neuropathies. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy. New York, NY: Demos Medical Publishing, 2012: 87–105.Google Scholar
United States Centers for Disease Control. Guidelines for the identification and management of lead exposure in pregnant and lactating women. 2010. Available from: www.cdc.gov/nceh/lead/publications/leadandpregnancy2010.pdf [last accessed September 28, 2021].Google Scholar
Allen, KA. Is prenatal lead exposure a concern in infancy? What is the evidence? Adv Neonatal Care 2015;15:416–420.Google Scholar
Hoffman, RS. Thallium poisoning during pregnancy: a case report and comprehensive literature review. J Toxicol Clin Toxicol 2000;38:767–775.Google Scholar
Milton, AH, Hussain, S, Akter, S, et al. A review of the effects of chronic arsenic exposure on adverse pregnancy outcomes. Int J Environ Res Public Health 2017;14:556.CrossRefGoogle ScholarPubMed
Chin, RL, Langsdorf, J, Feuer, N, et al. Nutritional and alcoholic neuropathies. In Donofrio, PD (Ed.), Textbook of Peripheral Neuropathy. New York, NY: Demos Medical Publishing, 2012: 69–85.Google Scholar
Hammoud, N, Jimenez-Shahed, J. Chronic neurologic effects of alcohol. Clin Liver Dis 2019;23:141–155.Google Scholar
Oei, JL. Alcohol use in pregnancy and its impact on the mother and child. Addiction 2020;115:2148–2163.Google Scholar
Magdaleno, R, Jr., Pereira, BG, Chaim, EA, et al. Pregnancy after bariatric surgery: a current view of maternal, obstetrical, and perinatal challenges. Arch Gynecol Obstet 2012;285:559–566.Google Scholar
Koffman, BM, Greenfield, LJ, Ali, II, et al. Neurologic complications after surgery for obesity. Muscle Nerve 2006;33:166–176.Google Scholar
Eerdekens, A, Debeer, A, Van Hoey, G, et al. Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr 2010;169:191–196.Google Scholar
Vilholm, OJ, Christensen, AA, Zedan, AH, et al. Drug-induced peripheral neuropathy. Basic Clin Pharmacol Toxicol 2014;115:185–192.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×