Anesth Pain Med.  2018 Apr;13(2):149-153. 10.17085/apm.2018.13.2.149.

Difficult intubation of a patient with progressive multifocal leukoencephalopathy and muscle spasticity: A case report

• Kim JE
• Yang YK
• Kwon MY
• Yun MJ
• Kim GH

• KMID: 2437420
• DOI: http://doi.org/10.17085/apm.2018.13.2.149

Abstract

Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease characterized by neurological deficits, including cognitive impairment, altered mental status, and muscle spasticity. Preoperative evaluation and intraoperative airway management of the airway is difficult in patients with this disease. In this report, the authors describe a 62-year-old man with PML and spastic hemiparesis, who was scheduled for video-assisted thoracic bullectomy under general anesthesia. A preoperative airway evaluation, including Mallampati classification, could not be performed due to lack of patient cooperation. Additionally, the anesthesiologist did not perform diverse physical assessments of the airway or prepare an adequate airway management strategy. During induction of general anesthesia, difficulty with intubation was encountered because of limited mouth opening. This case emphasizes that anesthesiologists should have thorough knowledge of airway assessment and management strategies, and perform a comprehensive assessment to implement appropriate airway management in patients with this disease.

Keyword

Intubation; Muscle spasticity; Progressive multifocal leukoencephalopathy

MeSH Terms

Airway Management
Anesthesia, General
Central Nervous System
Classification
Cognition Disorders
Humans
Intubation*
Leukoencephalopathy, Progressive Multifocal*
Middle Aged
Mouth
Muscle Spasticity*
Paresis
Patient Compliance

Figure

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  Fig. 1 (A) Axial T2-weighted magnetic resonance imaging of the brain. (B) Coronal T2-weighted magnetic resonance imaging of the brain. The arrow indicates the lesion showing diffuse high intense areas and atrophy of the bilateral cerebral white matter, including the corticobulbar tract.

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  Fig. 2 Photograph showing the patient’s limited passive mouth opening after surgery.

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