Neurology Experts Discuss Lack of Informed Consent During Nerve Resection

Case Overview

This case involves a male patient in Idaho with a medical history of cancer, which had been successfully treated. On the date of the incident in question, the patient underwent surgical resection of suspicious lymph nodes. Prior to the surgery, the patient had discussed with his surgeon his desire not to have any damage to his spinal accessory nerve. However, the informed consent made no mention of the potential for resection of the nerve. During the surgery, the surgeon decided to remove the nerve, and called in a plastic surgeon to perform a transplantation of a portion of another nerve in a graft. As a result, the patient lost the use of his right arm post-op. As a result, the man was unable to return to his previous occupation as a golf instructor.

Questions to the Security expert and their responses

Have you ever treated a patient similar to the one described in this case?

I have treated patients with mononeuropathy of the spinal accessory nerve. In one case, the injury was related to lymph node resection or biopsy. Injury to this nerve is a known complication of posterior triangle lymph node biopsy.

Is it possible that the patient's symptoms were caused by the intra-operative nerve resection/grafting?

It is possible that the patient's symptoms were caused by the procedure. A 50% loss of an upper extremity would not be expected from an isolated injury to the spinal accessory nerve. If one has bona fide CRPS, then there could be greater limitation. Moreover, there may be an issue with lack of informed consent.

About the expert

This highly qualified expert is board certified in neurology, clinical neurophysiology, electrodiagnostic medicine, and headache medicine. He is in full-time clinical practice with broad experience in clinical neurology and medical education. He is formerly the director of neurology rotation for emergency medicine and internal medicine residents at the University of Michigan and St. Joseph Mercy Hospital. He belongs to a number of prestigious societies in the neurology field, including the American Academy of Neurology and the American Association of Neuromuscular and Electrodiagnostic Medicine. Currently, this expert is a neurohospitalist in Clarkson, Michigan.

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