Median nerve injury: an underrecognised complication of brachial artery cardiac catheterisation?

被引:37
作者
Kennedy, AM
Grocott, M
Schwartz, MS
Modarres, H
Scott, M
Schon, F
机构
[1] ST GEORGES HLTH CARE TRUST,ATKINSON MORLEYS HOSP,REG NEUROSCI UNIT,LONDON SW20 0NE,ENGLAND
[2] QUEEN MARYS UNIV HOSP,DEPT PLAST & RECONSTRUCT SURG,LONDON SW15 5PN,ENGLAND
关键词
median neuropathy; brachial artery; left heart catheterisation; complication;
D O I
10.1136/jnnp.63.4.542
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective-To describe the local neurological complications associated with cardiac catheterisation via the right brachial artery. Methods-A follow up study to determine the mechanism of injury and outcome of patients who sustained a high median nerve palsy after this procedure. Five right handed patients were identified in a 24 month period. Each was assessed clinically and electrophysiologically at presentation. All were followed up initally (range six to 22 months) clinically, electrophysiologically, and using components from the Chessington occupational therapy neurological assessment battery (COTNAB) functional hand assessment. Results-The incidence of this complication was between 0.2 and 1.4%. Three mechanisms of injury were identified. These included direct nerve compression due to formation of antecubital fossa haematoma, direct nerve trauma, and ischaemia secondary to brachial artery occlusion. The initial neurological and nerve conduction deficits improved with time. However, all cases had persistent disability in hand function as documented clinically and on the dexterity and stereognosis subcomponent of the COTNAB test. Conclusion-This is an uncommon, but probably underrecognised complication. Those performing cardiac catheterisation via the right brachial artery should be aware of the potential risks of damage to the median nerve. They should evaluate hand function after the procedure and take prompt action if median nerve dysfunction is noted. Damage to the median nerve results in appreciable long term disability, which may have medicolegal relevance.
引用
收藏
页码:542 / 546
页数:5
相关论文
共 15 条
[1]   COMPLICATION RATE OF CORONARY ARTERIOGRAPHY - REVIEW OF 5250 CASES STUDIED BY A PERCUTANEOUS FEMORAL TECHNIQUE [J].
BOURASSA, MG ;
NOBLE, J .
CIRCULATION, 1976, 53 (01) :106-114
[2]  
CAMPION BC, 1971, MAYO CLIN PROC, V46, P589
[3]   COMPLICATIONS OF CORONARY ARTERIOGRAPHY FROM THE COLLABORATIVE STUDY OF CORONARY-ARTERY SURGERY (CASS) [J].
DAVIS, K ;
KENNEDY, JW ;
KEMP, HG ;
JUDKINS, MP ;
GOSSELIN, AJ ;
KILLIP, T .
CIRCULATION, 1979, 59 (06) :1105-1112
[4]   THE PREPONDERANCE OF POSTERIOR CIRCULATORY EVENTS IS INDEPENDENT OF THE ROUTE OF CARDIAC-CATHETERIZATION [J].
KEILSON, GR ;
SCHWARTZ, WJ ;
RECHT, LD .
STROKE, 1992, 23 (09) :1358-1359
[5]   NEUROPATHY AFTER CARDIAC-CATHETERIZATION - INCIDENCE, CLINICAL-PATTERNS, AND LONG-TERM OUTCOME [J].
KENT, KC ;
MOSCUCCI, M ;
GALLAGHER, SG ;
DIMATTIA, ST ;
SKILLMAN, JJ .
JOURNAL OF VASCULAR SURGERY, 1994, 19 (06) :1008-1014
[6]  
LITTLER WA, 1976, POSTGRAD MED J, V52, P110
[7]   MEDIAN-NERVE NEUROPATHY AFTER PERCUTANEOUS PUNCTURE OF BRACHIAL ARTERY IN PATIENTS RECEIVING ANTICOAGULANTS [J].
MACON, WL ;
FUTRELL, JW .
NEW ENGLAND JOURNAL OF MEDICINE, 1973, 288 (26) :1396-1397
[8]   COMPLICATIONS OF AXILLARY ARTERIOTOMIES - ANALYSIS OF 1,762 CONSECUTIVE STUDIES [J].
MOLNAR, W ;
PAUL, DJ .
RADIOLOGY, 1972, 104 (02) :269-&
[9]   NEUROPATHY INDUCED BY HEMORRHAGE [J].
PATTEN, BM .
ARCHIVES OF NEUROLOGY, 1969, 21 (04) :381-&
[10]   NEUROLOGICAL COMPLICATIONS FOLLOWING ARTERIAL CATHETERISATION BY AXILLARY APPROACH [J].
STAAL, A ;
VANVOORT.AE ;
VANDIJK, LM .
BRITISH JOURNAL OF RADIOLOGY, 1966, 39 (458) :115-&