Paraplegia Following Obstetric Spinal Anesthesia: A Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 19, Issue 2
Abstract
Neurologic complication following spinal anesthesia is rare, but it can lead to serious neurologic sequelae. Direct needle injury to the cord, epidural hematoma, epidural abscess, spinal cord infarction, cauda equina syndrome or compression from extradural mass have been documented as causes of paraplegia. We report a patient who developed paraplegia following an uneventful spinal anesthesia for caesarean section and underwent emergency surgery for a previously undiagnosed thoracic intradural extramedullary tumor which was thought to be the cause of neurologic complication.Neurological deficit is an uncommon but a catastrophic complication after spinal anesthesia. Neurologic complication as vertebral canal hematoma, epidural abscess, cauda equina syndrome, arachnoiditis, trauma, transient neurological syndrome following obstetric central neuraxial anesthesia have been documented [1]. We report the case of obstetric patient who developed paraplegia after spinal anesthesia.A 37 years old female with 38 weeks of gestation was planned for cesarean section due to breech presentation. The patient was healthy and was not taking any medication. The vital signs, general physical examinations and routine investigations were unremarkable. Spinal anesthesia was performed with aseptic technique at the L3-4 interspace in paramedian approach using a 27G Quincke spinal needle in a single attempt. After confirming entry by free flow of clear cerebrospinal fluid (CSF), 10mg of 0.5% hyperbaric bupivacaine with 0.2mg of morphine was given in a total volume of 2.2 ml. The patient then developed a sensory blockade up to T4 dermatomal level. Intraoperative course was uneventful and all the vital parameters were maintained within normal range. Eight hours after the surgery, the patient still had lower extremities weakness. She had no fever or back pain. Neurologic examinations revealed loss of sensation below L1 dermatome and decreased motor strength of both lower extremities, according to Medical Research Council grading, quantified as followed: bilateral hip flexion II/V; bilateral knee extension II/V; bilateral foot dorsiflexion IV/V; and bilateral plantar flexion IV/V. Both lower extremities showed increased muscle tone and prepatellar reflexes. Rectal and sphincter tone were decreased. Besides that, the patient also mentioned that 2 weeks prior to admission she started feeling numbness in legs but did not recognize that as a problem. An urgent magnetic resonance imaging (MRI) of thoracolumbar spine shows dural-based mass at posterior wall of thecal sac at the T10-T11 vertebral level with spinal cord compression (Figure 1). Microscopic decompressive laminotomy with tumor removal was operated on the next day. After surgery, the patient’s symptoms began to resolve, and she was able to walk with assistance. Pathological study of the tissue showing atypical meningioma (WHO grade II) was reported. Four months later, she was fully recovered and repeated MRI thoracolumbar spine showed no residual tumor (Figure 2).
Authors and Affiliations
Jedsadayoot Sakaroonchai, Arpakorn Kunawudhi, Preeyaphan Arunakul
Keywords
Related Articles
- EP ID EP621682
- DOI 10.26717/BJSTR.2019.19.003280
- Views 163
- Downloads 0
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