Anesthetic Management of a Patient With Hereditary Spastic Paraplegia: A Case Report

Hereditary spastic paraplegia is an extremely rare, heterogenous, inherited, progressive neurologic disorder characterized by lower-extremity weakness and spasticity in pure forms, with complex forms including symptoms such as seizures, dementia, and ataxia. Due to its rarity, evidence guiding anesthetic management is limited, consisting of only eight published case reports.

We report the anesthetic management of a patient with pure hereditary spastic paraplegia undergoing renal mass cryoablation in the prone position. General endotracheal anesthesia was induced with propofol, maintained with isoflurane, and included nondepolarizing neuromuscular blockade with reversal using sugammadex.

Patients with hereditary spastic paraplegia typically have experienced multiple anesthetic exposures prior to diagnosis, suggesting that standard anesthetic techniques are generally well-tolerated in this population without significant adverse effects. Given that pure HSP is an upper-motor neuron disorder-without involvement of the neuromuscular junction-extensive disease-specific modifications to anesthetic plans are likely unnecessary in the absence of additional comorbid risk factors.