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Excerpt
Postpartum neurologic complications, such as foot drop, occur in ∼1% of deliveries and are often blamed on epidural or spinal anesthesia. Some reports have implicated compression of the lumbosacral trunk by the fetal head at the pelvic brim or proximal sciatic or peroneal nerve injuries. The authors offered a report on a parturient with unidentified inherited neuropathy, which most likely contributed to postpartum foot drop.
The 28-yr-old woman presented 5 mo after a transverse cesarean section (CS) under epidural anesthesia for failure of descent during stage two. In the immediate postpartum period she had noticed a right foot drop, causing her to trip, and lateral right foot numbness. She received the diagnosis of iatrogenic L5 root injury after epidural anesthesia. She improved within a few weeks and was fully recovered at this 5-mo visit. There was no family history of neurological disease and a neurological exam was normal. It was found, however, that 8 yr previously, her left leg was similarly affected and she had paresthesia in the ulnar fingers of her left hand. Nerve conduction studies of the right leg showed pathologically small sural and peroneal sensory potentials, and the right radial sensory potential and right-arm motor conduction velocities were also reduced. This led to genetic testing, which revealed a typical 1.5 megabase deletion in the peripheral myelin protein-22 gene (PMP22), which is associated with hereditary neuropathy, with liability to pressure palsies (HNPP), an autosomal dominant condition with variable penetrance.
The authors concluded that it is highly probable that the woman's foot drop was caused by an intrapartum lumbosacral plexopathy or high sciatic neuropathy resulting from fetal head compression that caused segmental demyelination. PMP22 deficiency leads to the formation of unstable neuronal mature myelin, predisposing to demyelination, in transgenic animals. Another inherited neuropathy that can cause transient episodes of painful brachial plexopathy after childbirth is Hereditary Neuralgic Amyotrophy (HNA), which may be associated with dysmorphic features; however, there is no routinely available confirmatory genetic test for it. These neurological deficits typically resolve over days to months, but recovery can be delayed or incomplete; and there is no specific treatment for them.
