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Patients with cerebrovascular disease may have a history of a transient ischemic attack (TIA) or previous cerebral vascular accident (CVA). Important historical features to illicit from the patient include the timing and frequency of events and whether or not there are persistent sensory and motor deficits.²²

Raised intracranial pressure (ICP) can be life-threatening.²³ At its extreme, raised ICP can result in herniation of cerebral contents causing medullary dysfunction, cardiorespiratory instability, and ultimately death. In patients with central nervous system (CNS) pathology, signs and symptoms of increased ICP may include headache, nausea, vomiting, and papilledema.

Patients with CNS pathology should be questioned about a history of seizures, and if an episode(s) occurred, an attempt should be made to determine the type, frequency, and time of last occurrence. In addition, all anticonvulsant medications should be noted and continued in the perioperative period.²⁴

Patients who have a history of spinal cord injury are at risk for a number of perioperative complications, including respiratory failure, arrhythmias, autonomic hyperreflexia, hyperkalemia, pathologic fractures, and pressure sores.²⁵ It is important to document both the date and level of neurological injury, as many of these complications are dependent on such variables.

Regional anesthesia may be contraindicated in the presence of certain neurological injuries.

Extreme caution should be taken with disorders of the neuromuscular junction (NMJ), such as myasthenia gravis, as they will often result in unpredictable responses to neuromuscular blocking drugs. Lastly, beware that patients with muscular dystrophies and underlying myopathies are known to yield both an increased association with malignant hyperthermia (see Chapter 25) and an increased risk of postoperative respiratory failure.