Cranial nerve palsies following neuraxial blocks

Spinal anesthesia is one of the most frequently performed regional anesthesia techniques for a variety of surgeries worldwide. Cranial nerve palsy is a rarely reported complication of central neuraxial block. The etiology varies; however, it is most often associated with nerve compression or traction due to intracranial hypotension. In October 2023, we searched PubMed and Google Scholar databases for English-language articles published between 1952 and 2023. The following search terms were used in the search strategy: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal nerve palsies, and epidural, spinal anesthesia, or dural puncture. The search was limited to humans and case reports written in English. We analyzed 89 articles and case reports in this review. In this article, a review of 105 cases published so far in the literature is presented. Cranial nerve palsies were more common in obstetric and gynecological cases. The 6th cranial nerve palsy was reported most frequently. Paralysis of more than one cranial nerve may develop simultaneously and may be bilateral or unilateral. In general, unilateral paralysis has been observed. The most common finding in 3rd, 4th, and 6th cranial nerve palsies was diplopia. In 8th cranial nerve palsy, hearing loss was the most observed symptom. PDPH is mostly associated with cranial palsies in most cases. It was observed that early recognition of patients with symptoms and utilization of diagnostic methods were effective in treatment. The most common cranial nerve injuries following spinal and epidural anesthesia and dural puncture are 6th and 3rd cranial nerve palsies. Symptoms are believed to occur mainly due to variations in cerebrospinal fluid (CSF) pressure. It is recommended to design treatment plans based on the mechanism.