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Neurological Rehabilitation

Following Schwannoma resection, contralateral swelling leads to Brachial Plexopathy: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 7

    Poster Presenter(s)

  • Elyse N. Swope, DO

    Resident Physician
    University of North Carolina Hospitals PM&R Program
    Chapel Hill, North Carolina

    • Co-Author(s)

  • AR

    Anthony Reedy, MD

    Resident Physician
    University of North Carolina Hospitals PM&R Program
    Morrisville, North Carolina

Disclosure(s):
Elyse N. Swope, DO: No financial relationships to disclose
Case Diagnosis: 34-year-old male s/p vestibular schwannoma resection

Case Description or Program Description: The patient presented with left-sided hearing loss, headaches, and vertigo. Imaging showed a vestibular schwannoma extending into the IAC, creating compression in the CN5 brainstem. The mass was resected via rectosigmoid craniotomy without complication; however, after 2 hours, angioedema of the contralateral neck led to airway compromise, requiring re-intubation. CT demonstrated swelling in the right parotid, parapharyngeal, submandibular, superficial, and deep neck spaces with enlargement of the submandibular and parotid glands. Strength exam before intubation was significant for 0/5 of the right deltoid, 1/5 bicep, 3/5 tricep, and 4+/5 handgrip, along with right upper extremity neuropathic pain.

Setting: Tertiary care hospital

Assessment/Results: Cervical spine MRI was without evidence of cervical radiculopathy. EMG conducted 1-month postoperatively revealed a right brachial plexopathy affecting all three trunks, with upper trunk predominance. Four months post-operatively, after near resolution of neurologic deficits, an MSK ultrasound showed only mild intraneural swelling in the upper trunk of the right brachial plexus. Repeat EMG noted improvement in all three trunks with continued mild deficits of the upper trunk.

Discussion (relevance): Contralateral edema following schwannoma resection is an extremely rare complication. Differential diagnosis includes surgical positioning, sialadenitis, and positioning in conjunction with tight tracheal ties. Head rotation for surgical position can cause impaired lymphatic drainage and venous congestion, with subsequent swelling. Angioedema progressing to the proximal neck and shoulder girdle is even rarer, with very few case reports documenting a brachial plexopathy.

Conclusions: The edema described above could be due to venous or lymphatic obstruction; however, regardless of etiology, the delayed neck swelling was likely secondary to prolonged positioning. Ensuring optimal surgical access is important for patient outcomes, but we must realize that positioning can lead to unintended injury. In cases of nerve injury due to compression or traction, early intervention can dictate the prognosis of neurologic deficits.