Muscle weakness and paresthesia associated with epidural analgesia in a patient with an intrathecal neurofibrolipoma as part of a tethered cord syndrome.
We report a case of a 75-yr-old female patient in whom motor deficits and paresthesias occurred after lumbar epidural analgesia. These symptoms were eventually found to be due to a tethered cord syndrome. An epidural catheter was inserted for analgesia after colon surgery. The postoperative course was characterized by fluctuating sensory and motor symptoms. A magnetic resonance imaging scan showed an intraspinal mass, which was removed by laminectomy. The presented complication is of major interest because the intraspinal tumor, which must have been present for years, became acutely symptomatic. Tethered cord syndrome is caused by a limited longitudinal mobility of the cord. It is often seen as a part of spinal closure defects and is also associated with intrathecal tumors. Typically, adult patients complain of weak legs, paresthesias of the legs, and urinary incontinence. However, our patient had denied any muscular or neurological problems or urinary incontinence during the preoperative interview. Postoperative electromyogram and electroneurography ascertained chronic neurogenic lesions of multiple lumbar and sacral nerve roots. Three months after the operation, the patient was able to walk 100 m with a crutch.
Jetzek-Zader
Martin
M
*Klinik fuer Anaesthesiologie, †Chirurgische Klinik, and ‡Neurochirurgische Klinik, Universitaetsklinikum Duesseldorf, Duesseldorf, Germany.
Peterschulte
Guido
G
Ludwig
Ulrich
U
Lipfert
Peter
P
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000601:surgery; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018908:Muscle Weakness / Q000209:etiology*; D009436:Neural Tube Defects / Q000150:complications* / Q000473:pathology; D009455:Neurofibroma / Q000150:complications* / Q000473:pathology; D010292:Paresthesia / Q000209:etiology*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000473:pathology