UNEXPECTED NEUROLOGICAL DEFICITS FOLLOWING RECOVERY FROM ANESTHESIA

Two cases of neurological dysfunction are presented. Neurological defi cits after recovery from anaesthesia are unusual in young women periop eratively. In the first case, a 39-yr-old woman presented at 36-wk ges tation with antepartum haemorrhage and in labour Pregnancy had been co mplicated by pre-eclampsia and she underwent emergency Caesarean secti on under general anaesthesia without complication. The trachea was ext ubated when she was awake but almost immediately she became hypertensi ve, obtunded and reintubation was required. Her pupils became fixed an d dilated but the Computerised Axial Tomogram (CT) was normal A coagul opathy was evident. She made a full neurological recovery within 24 hr . On the same day, a previously healthy 41-yr-old woman who had underg one uneventful surgery for uterine prolapse 24 hr previously developed headache, nausea and over the next four hours signs of progressive br ainstem ischaemia. The CT scan showed oedema of the mid- and hindbrain . Brainstem death was confirmed 12 hr later and the post-mortem reveal ed acute dissection of the vertebral artery secondary to cystic medial necrosis. Such dramatic neurological sequelae are rare but the import ance of identifying ''at risk'' groups is underlined as is early recog nition of neurological injury postoperatively.