Abstract
A 15 year-old girl presented with acute psychosis, seizures and right shoulder dislocation with an overlying abscess. The symptomatology was diagnosed to be due to Wilson’s disease. The anaesthetic management and postoperative analgesia was a challenging task in presence of hepatic and acute neurological dysfunction as well as difficulty in pain assessment. There are only a few reported cases of anaesthetic management in patients with Wilson’s disease with severe neuropsychiatric symptoms. This case portrays the safe use of both general and regional anaesthesia in such a patient.
Highlights
A 15 year-old girl presented with acute psychosis, seizures and right shoulder dislocation with an overlying abscess
An ultrasound guided interscalene brachial plexus block was given at the end of surgery with 15ml of 0.25% bupivacaine using a 20G nerve stimulator needle
The presenting symptoms of delirium and involuntary movements in this case led to three differential diagnoses viz. Wilson’s disease, septic encephalopathy and adverse drug reaction
Summary
A 15 year-old girl presented with acute psychosis, seizures and right shoulder dislocation with an overlying abscess. Steroids and penicillamine were started with a presumptive diagnosis of Wilson’s disease. An ultrasound guided interscalene brachial plexus block was given at the end of surgery with 15ml of 0.25% bupivacaine using a 20G nerve stimulator needle.
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