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Transient neurological syndrome: does it really exist?

José L Aguilar1, R Peláez

  • 1Pain Clinic, Clínica Palmaplanas, Palma de Mallorca, Spain. jlaguilar@palmaplanas.com

Current Opinion in Anaesthesiology
|October 7, 2006
PubMed
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Transient neurologic syndrome, a complication of spinal anesthesia, may stem from local anesthetic toxicity. Studies reveal biochemical and cellular changes in neurons, suggesting a structural basis for this neurological condition.

Area of Science:

  • Neuroscience
  • Anesthesiology
  • Toxicology

Background:

  • Transient neurologic syndrome (TNS) is a clinical observation following spinal anesthesia.
  • The exact causes and contributing factors of TNS remain largely undetermined.
  • This review aims to elucidate TNS and its connection to spinal anesthesia.

Purpose of the Study:

  • To clarify the nature of transient neurologic syndrome.
  • To explore the relationship between local anesthetics and TNS.
  • To review the current understanding of TNS etiology.

Main Methods:

  • Review of clinical reports on TNS incidence.
  • Analysis of studies on intrathecal local anesthetic administration.
  • Examination of in-vitro neuronal studies.

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Main Results:

  • Intrathecal local anesthetics increase glutamate in cerebrospinal fluid.
  • Histopathologic changes in lumbar spinal cord motor neurons suggest nerve root damage.
  • In-vitro studies show local anesthetics affect neuronal growth cones and neurites.

Conclusions:

  • Biochemical and anatomopathologic findings support a structural basis for TNS.
  • TNS may represent the milder end of local anesthetic toxicity spectrum.
  • High concentrations of local anesthetics can cause irreversible neural injury; further research is needed.