title: Spontaneous spinal epidural haematoma: a rare cause of quadriplegia in the post-partum period.
abstract: Spontaneous spinal epidural haematoma (SSEH) is a rare cause of neurological deficit in the pregnant and post-partum patients. However, SSEH with associated myelitis presenting as quadriplegia and respiratory paralysis in the post-partum period has never been reported. We report the development of acute onset quadriplegia progressing to respiratory arrest in a 24-yr-old woman 2 weeks after normal vaginal delivery. There was no history suggestive of any coagulopathy (inherited or acquired), eclampsia, pre-existing neurological deficit, or iatrogenic manipulations such as spinal/epidural injections. Magnetic resonance imaging revealed a posterior epidural haematoma extending from C4-C7 and areas of signal changes in spinal cord from cervicomedullary junction to D5 level (suggestive of demyelination). We highlight this rare cause of quadriplegia; focusing on the altered dynamics of the epidural vasculature in the peripartum period leading to SSEH.
authors.affiliation: Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: S
authors.initials: S
authors.lastname: Bose
authors.forename: Z
authors.initials: Z
authors.lastname: Ali
authors.forename: G P
authors.initials: GP
authors.lastname: Rath
authors.forename: H
authors.initials: H
authors.lastname: Prabhakar
mesh_terms: D000328:Adult; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D009188:Myelitis, Transverse / Q000175:diagnosis / Q000209:etiology; D011644:Puerperal Disorders / Q000175:diagnosis*; D011782:Quadriplegia / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology