Postoperative neurological symptoms after anesthesia - diagnostic challenges, pathophysiology and a review of uncommon cases

Abstract

Introduction: Postoperative neurological symptoms following anesthesia are uncommon but may pose significant diagnostic challenges in the perioperative period. These manifestations can range from transient focal deficits to delayed or atypical neurological syndromes, and may occur in the absence of clear structural pathology. Diagnostic uncertainty is frequently compounded by residual anesthetic effects, perioperative physiological disturbances, and overlap with surgical or systemic complications.

Material and methods: A review of selected literature was conducted using the PubMed database. The search was performed using keywords including “postoperative neurological symptoms,” “anesthesia,” “neurological complications,” “delayed emergence,” “functional neurological disorders,” and “case reports”.

Summary: Reported postoperative neurological presentations include focal neurological deficits mimicking acute cerebrovascular events, movement disorders, cranial nerve dysfunction, visual and sensory disturbances, alterations in consciousness, functional neurological presentations, and delayed-onset symptoms emerging after initial recovery. These cases highlight the heterogeneity of postoperative neurological phenomena and suggest that multiple interacting mechanisms, rather than a single causative pathway, may contribute to their development.

Conclusions: Uncommon postoperative neurological symptoms associated with anesthesia remain diagnostically challenging and are primarily documented through isolated case reports and targeted reviews. Awareness of atypical presentations and careful clinical evaluation may assist in avoiding misdiagnosis and unnecessary interventions. Further systematic investigation may help clarify contributing factors and inform perioperative management strategies.

Keywords: Postoperative neurological symptoms; anesthesia; diagnostic challenges; case reports; uncommon complications.