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- W1481086722 abstract "To the Editor: An 86-year-old woman was admitted with the complaint of bilateral foot drop. Two months before, after a fall episode, she had been in the intensive care unit because of her deteriorated general condition. During her stay, she had gastrointestinal bleeding from the ileocecal region, and right hemicolectomy, subtotal small intestine resection, and jejunotransversostomy operations in the lithotomy position had to be performed. She indicated that she began to suffer from weakness in her feet immediately after surgery. In the interim, she had become immobile because of deconditioning and difficulty in walking. Her current physical examination revealed bilateral drop foot, limited hip rotation, and limited and painful knee flexion. The neurological examination was consistent with minimal proximal weakness (4/5) and bilateral weakness (2/5) in the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneal muscles. Babinski reflexes were negative bilaterally. There was not any sensory deficit, and arterial pulses were intact. Electrodiagnostic evaluations of all the extremities yielded diffuse polyneuropathy and peroneal nerve entrapment at the level of the fibular head bilaterally. Other physical examination and laboratory findings were unremarkable. The patient was started on a physical therapy program that comprised electrical stimulation and strengthening exercises for the lower limbs along with balance and coordination exercises. She was discharged after 1 month of rehabilitation when she could walk independently with a tripod. Age-related changes consisting of reduced fiber density and loss of myelinated and nonmyelinated axons have been shown to occur in the peripheral nerves of otherwise normal people aged 60 and older,1–3 although because of the lack of obvious clinical signs and noninvasive laboratory findings that could connect them to a systematic affliction or to a metabolic, toxic, or inammatory process,4 the majority of these neuropathies may pose diagnostic challenges and may even be overlooked. Likewise, the polyneuropathy in our patient had not been diagnosed earlier. Alternatively, entrapment of the peroneal nerve at the fibular head is the most common mononeuropathy of the lower extremities; the underlying etiologies are mainly staying in the same position for an extended period, surgery, weight loss, trauma, and external compression due to casts or nearby mass lesions.5,6 With regard to surgery, positioning for lithotomy, particularly during colorectal and gynecological operations, has been reported to cause peroneal neuropathy.7 Although peroneal neuropathy is usually expected to have a good prognosis, it might become disabling, especially in patients with bilateral involvement. Similarly, peroneal entrapment in this patient was considered to be due to prolonged stay in the lithotomy position. Overall, presenting this elderly patient draws attention to this untoward eventuality. Clinicians and surgeons must exercise care and vigilance during relevant surgeries, especially in elderly patients, whose peripheral nerves are prone to extrinsic injuries. Furthermore, slender body build, diabetes mellitus, and prolonged operative time could be the other unfavorable factors that should be taken into consideration. Accordingly, preventive measures such as repositioning the patient, using alternative positions, and soft padding of the knee will help minimize neural compromise. No elderly patient wants to wake up from surgery with such an unforeseen disability in addition to possible preexisting gait disturbances. Conflict of Interest: The checklist table for financial and personal conflicts have been reviewed by the editor in chief, and he has determined that none of the authors have any conflicts of interest in regards to this paper. Author Contributions: Erkan Kılıç and Özlem Erol followed the patient on the ward. Levent Özçakar was the senior consultant. Erkan Kılıç, Erkan Özgüçlü, and Levent Özçakar prepared the manuscript. Sponsor's Role: Not applicable." @default.
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- W1481086722 date "2007-11-01" @default.
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- W1481086722 title "BILATERAL FOOT DROP AFTER INTESTINAL SURGERY: PERONEAL NEUROPATHY UNABATED IN ELDERLY PATIENTS" @default.
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- W1481086722 doi "https://doi.org/10.1111/j.1532-5415.2007.01433.x" @default.
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