Neurologic symptoms after epidural anaesthesia. Report of three cases.
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.
Department of Neuroanesthesia and Intensive Care, National Neurological Institute of Milan C. Besta, Italy.
M
M
Gemma
M
M
Bricchi
M
M
Grisoli
S
S
Visintini
D
D
Pareyson
A
A
Sghirlanzoni
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001100:Arachnoiditis / Q000209:etiology; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D013118:Spinal Cord Diseases / Q000209:etiology*