Nerve Damage after intubation

[ChristineOW]

Because of my shoulder surger it is hard to type. So I am going to post an email my husband and I sent to a Neurologist but have not received anything from him. I am scheduled for emg and other test soon but this is really getting to me. I was wondering if anyone can let me know if this could be perminent. This is lasting a long time and I am hoping it goes away soon.

My name is Aaron Dickerson and I am writing to you in the hopes that you can give my wife and I some guidance on which direction we should go.  Evonne, my wife, recently had surgery on her left shoulder to have some calcification removed from the socket.  The surgery was on April 8th.  The procedure was performed at Naval Hospital Oak Harbor as a same day procedure.  Immediately following the surgery, she lost complete control of the right side of her tongue.  There is some obvious deviation in the tongue, and here ability to speak and eat has been severely affected.  Through research of my own, I read about Tapia Syndrome and provided that information to the Anesthesia department at the Naval Hospital.  I know that Tapia Syndrome (at least the case that I read about on-line) also affects the vocal chords.  In my wife's case, those have not been affected.  We asked Dr Willock, the senior Anesthesiologist on staff at the hospital if he had ever seen a case like this.  He stated that he had seen a couple of similar cases, but neither of those had the obvious deviation of the tongue that my wife has.  He was going to start her on a steroid treatment, but could not provide my wife any answers as to why this was happening, or how long it would last, so she asked to be sent to a Neurologist.  We went to see Dr Robert Price in Everett on the 13th of April for an initial consultation.  His analysis was that the nerve was somehow injured during the surgery and wants us to wait another 2 weeks before he performs an EMG to see the extent of the damage.  Following our visit to Dr Price, I spoke with a family friend, who is an Anesthetist.  He explained to me that the most likely cause of Evonne's injury was a misalignment of the head/neck after they rolled her onto her right side after intubation.  



We are aware that this complication is very rare, and we are just looking for answers.  I don't think anyone at the Naval Hospital knows what to tell us because they simply have not seen anything like this before.  We were just hoping that in your experiences, you may have seen this before and could possibly give us some guidance.

[ChristineOW]

I have a quick question regarding what you have said. Given that it could have been a form of a mini stroke due to a clot. Could I still be a risk now? Could the clot still be there?

[ChristineOW]

Thank you so much. I am getting the feeling that they really do not know what to do or that they are just wishing and hoping it goes away. I have the anesthetist that was in surgery with me calling my home once a week to see how things are going. He keeps telling me that i am a person of interest to the hospital. I am so sick of them actually. I demanded to be sent to a specialist out of network and they finally did do that. I wanted nothing more do with them treating me. It has been a run around with our insurance and finally getting in to see one but not until next month. I do not even know if this new neurologist has seen this before. I am and have been reasearching things on the net but htis is the first for what you have said. So I hope you do not mind me taking this with me when I go in.

Thank you

[caregiver222]

For the record, my information does not come from "the net". Thirty-five years ago I was an observor in an emergency room when they were performing cartotid massage to control tachycardia in a cocaine overdose, female. At the time that was hospital protocol. She "stroked out" during the procedure with complete right side tongue dfelection and difficulty in swallowing. As you know hospitals have committee to meet and discuss complications and this case was present and I remember the outcome. One has to be very careful when manipulating the neck.  In addition I am endotracheally certified and have performed over 900 endotracheal intubations.

[caregiver222]

I disagree entirely with the reasons provided by the physicians. You have damage to the 12th cranial nerve, probably cause by a clot dislodged within the carotid arteries during manipulation during the surgery. Sort of a mini stroke. There are atheroschelotic deposits in the carotids of some people and you should have had a carotid ultrasound before the procedure, which, I am sure, they didn't do. Shhhhh.  The clot blocked off the blood supply and the nerve atrophied. It isn't that uncommon. They needed to administer clot dissolves,  of which there are several (streptokinease being one of them) but they were on space chips and did not properly observe you during the post-surgical period.  The doctor is suppossed to ask you to stick out your tongue after the surgery and say "ahh". That's to check for 12th cranial nerve damage. They didn't do this. The tongue will deviate in the direction of the damage.

The nerve was "somehow injured"....sigh. Baloney on toast with mayo.

You should have been immediately transferred to the neuo ward and been treated as a stroke victim within the four nhour window of oppurtunity.

It would appear to me you are getting a snow job, because this should be obvious to a first year nursing student.

The treatment is B-12 with folic acid sublinguilly, alpha-lipoic acid and it would be illegal for me to recommend diluted DSMO, so I won't. Never said that. Initially a few days of a steroid such as prednisone wouldn't hurt.

Sometimes these conditions resolve on their own, which is the good news. The literature says they don;t but the literature is wrong.

You need a 3T MRI, not a 1T or a 2T.