• Neurosurgery · Mar 2018

    A Neglected Cause of Iatrogenic Brachial Plexus Injuries in Psychiatric Patients.

    • José Fernando Guedes-Corrêa, Maristella Reis da Costa Pereira, Francisco José Lourenço Torrão-Junior, José Vicente Martins, and Daniel Alves Neiva Barbosa.
    • Division of Neurosurgery. Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
    • Neurosurgery. 2018 Mar 1; 82 (3): 307-311.

    BackgroundPsychiatric patients are often kept immobilized during hospitalization to avoid self-inflicted injuries and danger to third parties. Inadequate positioning can lead to brachial plexus injuries (BPI).ObjectiveTo present a series of 5 psychiatric patients with BPI after being left sedated and restrained for prolonged periods of time during hospitalization.MethodsWe retrospectively reviewed the charts of 5 psychiatric patients with iatrogenic BPI referred by other institutions to our service. The restraint technique adopted by those institutions consisted of a high-thoracic restraint. All patients underwent complete clinical and neurological examination at our center. Information concerning patient demographics, BPI characteristics, treatment choice, and ultimate outcome was recorded.ResultsThree patients were male. The age of our patients ranged from 25 to 61 years old (mean: 41.2; median: 43). Three patients had a diagnosis of bipolar disorder while 2 had schizophrenia. Duration of immobilization ranged from 5 to 168 h (mean: 77.8; median: 72). Four patients presented with a unilateral right-sided lesion. Time to presentation ranged from 1 to 9 mo (mean: 4.2; median: 4). All patients also had intense pain and axillary lesions. Four patients received conservative treatment with partial or full functional recovery and complete pain resolution. The remaining patients underwent surgical repair and experienced good functional outcome.ConclusionPsychiatric patients who need to be sedated and immobilized must be monitored closely, as BPI can occur from high-thoracic restraints. When such an injury occurs, the patient must be referred to a center specialized in peripheral nerve surgery and rehabilitation.Copyright © 2017 by the Congress of Neurological Surgeons

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