Neuropathy in burn patients.

Neuropathic complications of the burn patient are frequently undiagnosed. A retrospective study was performed looking at neuropathies in patients admitted to a tertiary care burns centre from 1984 to 1991. Nineteen out of a total of 800 patients had signs and symptoms of neuropathy, confirmed on neurophysiological testing. Most patients were severely burned with 11 patients (69%) having a total burn surface area of > 20%. Twenty-eight percent were full thickness burns. Mononeuritis multiplex was the most common finding in these patients, occurring in 11 (69%). This has not been reported before. Three patients (19%) had an isolated mononeuropathy, one (6%) had a radiculopathy and one had a generalized axonal polyneuropathy. Of the patients with mononeuropathy, nine had lesions only in burned areas and four had lesions in burned and unburned areas. Eleven patients had complications of sepsis with five also having renal failure. Age, sex, serum albumin, magnesium, phosphate, creatinine, the presence of sepsis and the number or type of drug did not correlate with the number of affected nerves nor the extent of recovery. The length of hospitalization and severity of the burns were the only two factors which correlated with the number of affected nerves. Vascular occlusion of the vasa nervorum, direct thermal injury or a disseminated neurotoxin are postulated as possible aetiological mechanisms.