A 72-Year-Old Hospitalized Man Is Evaluated for New-Onset Paresthesia in the Right

A 72-year-old hospitalized man is evaluated for new-onset paresthesia in the right hand.  The patient was admitted to the intensive care unit 4 days ago due to pneumonia complicated by respiratory failure and septic shock.  He was mechanically ventilated and treated with broad-spectrum antibiotics, intravenous fluids, and vasopressor therapy.  Hemodynamic monitoring was performed using a right internal jugular venous catheter and a right brachial arterial catheter.  The patient's clinical condition gradually improved.  Today, he was extubated, and the arterial and venous catheters were removed.  Since extubation, the patient has reported right hand discomfort with tingling and numbness.  On examination, both hands are warm with 2-second capillary refill.  Bilateral grip strength is diminished but symmetric, and sensation to light touch and pain is diminished in the lateral palm, thumb, index finger, and long finger of the right hand.  Which of the following is the most likely cause of this patient's hand symptoms?

A) Brachial artery thrombosis
B) Brachial plexus compression
C) Cerebral infarction
D) Critical illness neuropathy
E) Median nerve injury
F) Vasopressor extravasation

Correct Answer:

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