Hitting A Nerve: T1 Nerve Root Injury Secondary to Open Heart Surgery

Patients who undergo cardiothoracic surgery and sternotomy can experience cardiovascular complications from manipulation of the great vessels or artificial pump bypass of the heart, raising the fear of stroke in the setting of focal neurological deficit. However, this study reveals a less common but often as focal and debilitating complication of these surgeries from direct injury of the peripheral nerves under prolonged physical tension.

This case details the presentation of a 72-year-old woman who developed acute left upper extremity weakness following elective open-heart surgery. Imaging ruled out ischemic or hemorrhagic stroke, and instead revealed a brachial plexus injury, with the most severe injury being on the T1 nerve root. This injury, leading to left upper extremity weakness, was diagnosed after advanced imaging and physical examination. The patient's symptoms gradually improved with supportive management and physical therapy.

This case underscores the importance of considering nerve injuries in the differential diagnosis of postoperative weakness and highlights the role of advanced imaging and electromyography in confirming brachial plexus injuries. Early recognition and appropriate management are essential for optimizing recovery in patients with iatrogenic brachial plexopathy.