Autoimmune anti-N-methyl-D-aspartate receptor encephalitis - the current state of knowledge based on a clinical case.

The aim of this article is to conduct an overview of the current state of knowledge about patients presenting anti-Nmethyl- D-aspartate receptor encephalitis associated with neoplastic process, as well as diagnosis and treatment. This disease concerns mainly young women and correlates with ovarian teratoma. Most important problems seems to be the difficulties in making a proper diagnosis ensuing from the rarity of this syndrome, the period from the appearance the first symptoms to starting treatment and the correct handling of intensive care complications. There are only a few articles describing severe, complicated cases of this type of encephalitis, requiring treatment in an intensive care unit.

Tapia's syndrome after arthroscopic shoulder stabilisation under general anaesthesia and LMA.

BACKGROUND: Anaesthetic complications, albeit rare, still occur and may be severe and unanticipated, with significant morbidity. Extracranial ipsilateral palsy of the recurrent laryngeal and the hypoglossal nerves is known as the Tapia's syndrome. Damage to these nerves may result from displacement of the head during mask ventilation, endotracheal intubation, bronchoscopy or the use of a laryngeal mask airway (LMA). We describe unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord due to a lesion of cranial nerves X and XII that occurred following LMA anaesthesia combined with plexus block. CASE REPORT: A 57-year-old man with a rupture of the right shoulder underwent arthroscopic shoulder stabilisation and internal fixation. General anaesthesia with aLMA was combined with an interscalene plexus block. After induction with propofol and fentanyl, a LMA was inserted with some difficulty without muscle relaxation. The cuff was inflated with 30 mL of air and further volumes of air until a "just-seal" pressure was obtained. The anaesthesia was maintained with sevoflurane in oxygen/air. The procedure was carried out in a semi-supine position with the head inclined slightly forward, and the upper body slightly elevated. Surgery lasted 55 min and anaesthesia 70 min. After surgery, the patient quickly regained consciousness and the LMA was removed when he was responding to commands and was able to fully open his mouth. During the immediate postoperative period, the patient's voice was hoarse but he breathed without difficulty. The following day, he developed dysphagia and slurred speech; on examination, paralysis of the left side of the tongue was found. The diagnosis of an acute injury to the hypoglossal and laryngeal recurrent nerves was made and the patient was transferred to the neurology clinic for further treatment. CONCLUSIONS: This rare complication reminds us not only of the importance of positioning during anaesthesia and surgery, but also of the need for careful and correct airway management. It could be probably prevented by careful insertion of an appropriate size LMA, and the use of low intracuff pressures and/or volumes.