title: Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient.
abstract: BACKGROUND
  Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient.
  
  
  METHODS
  A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks.
  
  
  CONCLUSIONS
  Pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. Pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.
authors.affiliation: Department of Anesthesia, University of Iowa Hospitals and Clinics, 6 JPC Iowa City, 52242-1079, USA. Sebastian-schulz-stubner@uiowa.edu
authors.forename: S
authors.initials: S
authors.lastname: Schulz-Stübner
mesh_terms: D020209:Cranial Nerve Injuries / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology*; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011187:Posture / Q000502:physiology*; D013961:Thyroid Gland / Q000601:surgery*