{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:06Z","timestamp":1779361626069,"version":"3.51.4"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"18","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Differential awakening is a well-known, yet poorly understood phenomenon seen in patients with intracranial pathologies. Because acute postoperative neurological decline has many potentially reversible causes, distinguishing differential awakening from other etiologies is critical. To the authors\u2019 knowledge, differential awakening has not been reported following peripheral nerve procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 40-year-old man presented with a 1.5-year history of painful bilateral cervical and right lumbosacral radiculoplexus neuropathy recently associated with bilateral facial and vestibulocochlear neuropathy. He had not responded to treatment trials. A sciatic nerve lesion in the sciatic notch was identified on imaging and an open biopsy of the posterior femoral cutaneous nerve was pursued. Immediately after emergence from anesthesia, he demonstrated a complete inability to dorsiflex or plantar flex the right foot, despite minimal intraoperative manipulation of the sciatic nerve. Over the ensuing hour, motor function progressively returned to baseline. The transient postoperative motor deficit was attributed to differential awakening of the sciatic nerve. Pathological analysis confirmed high-grade B-cell lymphoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Differential awakening may be an underrecognized cause of transient neurological worsening during emergence from anesthesia following peripheral nerve surgery. Further investigation is needed to clarify the underlying mechanisms and define its incidence and risk factors.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE251028\">https:\/\/thejns.org\/doi\/10.3171\/CASE251028<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case251028","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:15:32Z","timestamp":1778516132000},"source":"Crossref","is-referenced-by-count":0,"title":["Differential awakening of the sciatic nerve: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"William D.","family":"Chow","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8715-6651","authenticated-orcid":true,"given":"Pavlos","family":"Texakalidis","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2693-535X","authenticated-orcid":true,"given":"Felipe J. S.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-7763","authenticated-orcid":true,"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Anesth Analg","first-page":"467","article-title":"Differential awakening","volume":"75","author":"Cucchiara","year":"1992","unstructured":"Cucchiara RF.Differential awakening. Anesth Analg. 1992;75(3):467. doi:10.1213\/00000539-199209000-00036"},{"issue":"1","key":"bib2","series-title":"Anesthesiology","first-page":"21","article-title":"Exacerbation or unmasking of focal neurologic deficits by sedatives","volume":"85","author":"Thal","year":"1996","unstructured":"Thal GDSzabo MDLopez-Bresnahan MCrosby G.Exacerbation or unmasking of focal neurologic deficits by sedatives. Anesthesiology. 1996;85(1):21-25. doi:10.1097\/00000542-199607000-00004"},{"issue":"3","key":"bib3","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique","volume":"39","author":"Capek","year":"2015","unstructured":"Capek SAmrami KKDyck PJBSpinner RJ.Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique. Neurosurg Focus. 2015;39(3):E12. doi:10.3171\/2015.6.FOCUS15213"},{"issue":"5","key":"bib4","series-title":"Anesthesiology","first-page":"844","article-title":"Exacerbated spinal neurologic deficit during sedation of a patient with cervical spondylosis","volume":"67","author":"Miller","year":"1987","unstructured":"Miller RACrosby GSundaram P.Exacerbated spinal neurologic deficit during sedation of a patient with cervical spondylosis. Anesthesiology. 1987;67(5):844-846. doi:10.1097\/00000542-198711000-00046"},{"issue":"2","key":"bib5","series-title":"J Clin Anesth","first-page":"131","article-title":"Transient anesthetic-induced worsening of existing left-sided weakness in a patient undergoing elective anterior cervical discectomy","volume":"21","author":"Joffe","year":"2009","unstructured":"Joffe AMAhmed ATrost GRWillman K.Transient anesthetic-induced worsening of existing left-sided weakness in a patient undergoing elective anterior cervical discectomy. 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Stroke. 2002;33(1):283-285. doi:10.1161\/hs0102.101222"},{"issue":"3","key":"bib7","series-title":"Anesthesiology","first-page":"598","article-title":"Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner","volume":"124","author":"Lin","year":"2016","unstructured":"Lin NHan RZhou JGelb AW.Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner. 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