Postoperative Neurological Deficits Following Regional Anesthesia: A Rare Case of Transient Aphasia and Hemiparesis

Neurological impairments after anesthesia are fairly common and can oftentimes be serious. A thorough patient evaluation is imperative to discriminate between impairments related to the anesthesia itself and more serious, unrelated complications. Transient motor deficits, aphasia, and postoperative delirium have been reported after general anesthesia and can be related to perioperative stress, exacerbation of previous undiagnosed neurological disorders, and the under-reported psycho-emotional effects of undergoing anesthesia. We present the case of a 57-year-old female who developed expressive aphasia and right-sided weakness following elective ankle arthrodesis performed under monitored anesthesia care (MAC) with regional anesthesia. Medical history was significant for type 2 diabetes mellitus (T2DM), hypertension (HTN), chronic kidney disease (CKD), and Charcot joint. Her presentation sparked initial concern for a cerebrovascular event; however, imaging ruled out stroke and large vessel occlusion. Her neurological deficits were attributed to a rare and under-reported anesthesia-related complication: the psycho-emotional effects of regional anesthesia. The patient demonstrated a gradual recovery of speech and motor function without additional interventions and required inpatient rehabilitation to regain functional independence. This case highlights the importance of prompt evaluation of postoperative neurological symptoms, particularly in patients with significant comorbidities, and underscores the need for increased awareness of rare complications associated with anesthesia.