Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

Abstract

Study design: Case report. Setting: Tertiary referral spinal surgery center in South India. Objectives: To report a patient who developed epidural hematoma following epidural anesthesia causing acute paraplegia. Surgery was avoided due to concomitant gastrointestinal bleeding and poor general condition. Patient showed early signs of recovery with complete resolution of neurological deficits in 12 weeks. Conclusion: Surgery can be avoided in patients who show early signs of neurological recovery following epidural hematoma.

Spinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol

“…In some case reports, conservative therapy resulted in the spontaneous disappearance of the hematoma [12,13]. In our patient, the emergency surgery was selected according to the judgment of orthopedic surgeons, because of the MRI fi ndings and the progress of clinical symptoms.…”

Spontaneous Recovery of Paraplegia Caused by Spinal Epidural Hematoma after Removal of Epidural Catheter

“…Risk factors for SEH associated with epidural anesthesia are female sex, old age, a history of gastrointestinal bleeding, anticoagulant therapy, coagulopathy, hepatic dysfunction, and difficult or traumatic epidural catheterization and bleeding at the puncture site [2, 5, 13]. Even if bleeding occurs in the epidural space, it usually stops rapidly [13]; however, a large hematoma may accumulate in the epidural space of patients with coagulopathy or liver dysfunction and those taking anticoagulants [13].…”

“…Spinal epidural hematoma may occur in patients with normal clotting function [5, 13, 14]. It may present when an epidural catheter is in situ or after its removal [2–10]. In this case, the patient vomited after removal of the epidural catheter, and thereafter paraplegia occurred rapidly.…”

“…Nonetheless, we found nine reports of patients with SEH associated with epidural anesthesia whose symptoms recovered spontaneously [2–10]. Three of these cases are not discussed herein, as they did not develop paraplegia [8–10].…”

“…It is recommended that surgery is undertaken as quickly as possible to avoid permanent neurologic deficits [1]. Nonetheless, there have been some reports of spontaneous resolution of neurologic deficits caused by SEH associated with epidural anesthesia [2–10]. …”