Case Diagnosis: 16 year old male with a history of a traumatic brain injury with resultant spastic quadriplegia underwent routine phenol injections and developed painful superficial venous thromboses in his right lower extremity.
Case Description or Program Description: To combat his spasticity patient underwent phenol injections to all of the right tibial branches and right peroneal nerve (total of 5 injections). Patient had no immediate adverse effects from phenol injections. Patient’s spasticity did improve with the above interventions and he continued with his neurologic rehabilitation.
Setting: Acute Inpatient Rehabilitation Hospital
Assessment/Results: 30 days after phenol injections into the right lower extremity family reported poor sleep, restlessness, mild tachycardia and elevated blood pressure. Father also noted hard small nodules in his right calf. These 3 nodules were grossly palpated and were immobile. Patient grimaced with palpation. Right lower extremity doppler showed 2 non-compressible foci of hyoechogenicity within the right soleus muscle corresponding with short segment perforator veins. No history of other trauma to the right leg.
Discussion (relevance): By the far the most discussed adverse effect associated with phenol neurolysis is prolonged dysesthesias. To our best knowledge, there are no documented reports of a patient developing clinically significant superficial venous thromboses. This severe TBI patient had significant discomfort in his right calf causing tachycardia, hypertension and poor sleep for several days prior to definitive diagnosis being made.
Conclusions: Although superficial venous thromboses pose a very low risk for life threatening events, the thromboses can be a pain generator for individuals putting brain injury patients at risk for paroxysmal sympathetic hyperactivity. As the popularity for the use of phenol neurolysis grows, especially in patients who may have severe deficits in communication, it is important to be aware of this potential and carefully assess injection sites.
.jpg)
