title: Bilateral lower limb hypoesthesia after radical prostatectomy in the hyperlordotic position under general anesthesia.
abstract: OBJECTIVE
  To report a case of postoperative bilateral lower limb hypoesthesia occurring after surgery under general anesthesia in the hyperlordotic position for radical prostatectomy. The possible pathophysiologic mechanisms are discussed.
  
  
  METHODS
  This 52-yr-old patient was slightly overweight and was on fenofibrate for hypercholesterolemia. He had no history of cardiovascular disease. Arterial blood pressure was overall well maintained except for a very transient hypotension at surgical incision. Blood loss was moderate and did not require transfusion. Soon after recovery, the patient complained of paresthesia in both legs and neurological examination revealed bilateral lower limb hypoesthesia, compatible with an incomplete medullar syndrome at the level of T12-L1. On postoperative day one, a plain magnetic resonance imaging scan demonstrated a hyperintense signal in the spinal cord from T8 to T9 on T2-weighted images consistent with ischemia of the spinal cord whereas the heterogeneous aspect of the spinal cord was due to an unusually high fat content of the epidural space. Neurological signs improved progressively and one week later the patient had recovered normal sensory functions of both lower limbs.
  
  
  CONCLUSIONS
  Although arterial ischemia is the most common cause of postoperative spinal cord injury, other mechanisms may be invoked. We raise the possibility that a combination of intraoperative risk factors (hypotension, excessive postural changes) with anatomic predispositions (increased epidural venous pressure or fat content, previous bone disease) can produce arterial and/or venous ischemia of the spinal cord.
authors.affiliation: Department of Anesthesiology, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Beloeil
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.forename: Sophie
authors.initials: S
authors.lastname: Hoen
authors.forename: Pascal
authors.initials: P
authors.lastname: Eschwege
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
mesh_terms: D006801:Humans; D006987:Hypesthesia / Q000209:etiology*; D035002:Lower Extremity; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011187:Posture; D011468:Prostatectomy; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology*; D013131:Spine