Neurologic symptoms after epidural anaesthesia. Report of three cases

Abstract

We describe 3 patients, who exhibited neurological symptoms after single dose epidural anaesthesia. In patient 1 an unrecognized spinal arteriovenous fistula (AVF) caused paraparesis following epidural block. The dilated veins draining an AVF are space-occupying structures and the injection of the anaesthetic solution may have precipitated latent ischaemic hypoxia of the spinal cord due to raised venous pressure. In patient 2, epidural block was followed by postoperative permanent saddle pain and hypoaesthesia. The injection of the anaesthetic in a narrow spinal canal with multiple discal protrusions and restriction of interlaminar foramina may have acutely produced mechanical compression of the spinal cord or roots. Patient 3 exhibited post-epidural block spinal arachnoiditis. Although the few reported cases of this syndrome exhibit severe neurological damage, our patient presented with scarse symptoms. Our cases point out the importance of accurate neurological history and examination of candidates for epidural anaesthesia and of accurate anaesthetic history for neurological patients.

Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review

“…This case and other reports of delayed neurological deficit secondary to adhesive arachnoiditis following apparently routine central neuraxial anaesthesia share significant similarities [22,[24][25][26]29]. Within the broad spectrum of adhesive arachnoiditis, a subgroup of patients may be emerging who are prone to develop severe neurological symptoms relatively rapidly -within weeks or months of central neuraxial anaesthesia -in response to blood, perhaps local anaesthetics or traces of contaminants.…”

“…Neurological complications are uncommon and almost invariably temporary [17,18,21]. These can result from direct trauma to neural elements or, more rarely, through introduction of infection, hypoxic cord injury, expanding epidural haematomas or injection of anaesthetic into or adjacent to a canal already critically stenosed by osteophytes, disc protusion or less common abnormalities, such as arteriovenous fistulae [22]. Adhesive arachnoiditis is a rare, but recognised cause of neurological deficit following central neuraxial anaesthesia [5,12,17,[22][23][24][25][26][27][28][29].…”

Disseminated Staphylococcus aureus infection following spinal anesthesia: a case report

“…Complications of spinal anesthesia are uncommon and usually temporary [9]. The most common complications include direct injury to neural elements, expanding epidural hematoma, and injection of disinfection agents into subarachnoid space [10][11][12]. Disseminated S aureus infection involving the central nervous system and lung following spinal anesthesia has never been reported in the literature.…”

Arachnoiditis and epidural fibrosis: the Relationship to chronic pain

“…Martin [18] also reported asymptomatic arachnoiditis. Gemma [43] reported a case of postepidural block arachnoiditis, but noted "scarce symptoms. "…”