title: Epidural anesthesia for Cesarean delivery in a patient with post-traumatic cervical syringomyelia.
abstract: OBJECTIVE
  To illustrate the successful management of a patient with post-traumatic syringomyelia (PTS) and chronic pain syndrome who presented for elective Cesarean delivery under epidural anesthesia.
  
  
  RESULTS
  A 30-yr-old gravida 3 para 1 woman, with a known diagnosis of cervical PTS secondary to a whiplash injury sustained three years earlier, presented to the labour and delivery unit at 31 weeks' gestation. She had severe pain in the cervical and lumbar spine, motor and sensory deficits in the upper extremities, tender mass in her left trapezius muscle, and history of dizziness and syncopal episodes. She was taking oxycodone 120 mg·day(-1) Magnetic resonance imaging of her spine revealed a syrinx of 2 mm in diameter extending from C4 to T1 levels with disc protrusions in the C4-C6 region. There was no evidence of Arnold-Chiari malformation or elevated intracranial pressure. On airway examination, her Mallampati score appeared normal, but there was a limitation in the range of her neck movements in all directions. An elective Cesarean delivery was planned at 39 weeks' gestation. An epidural catheter was placed using ultrasound guidance, and the procedure was performed without complications.
  
  
  CONCLUSIONS
  The successful management of this case suggests that epidural can be considered in women with cervical PTS presenting for a Cesarean delivery.
authors.affiliation: Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Women's College Hospital, ON, Canada. claritamargarido@hotmail.com
authors.forename: Clarita
authors.initials: C
authors.lastname: Margarido
authors.forename: Rafeek
authors.initials: R
authors.lastname: Mikhael
authors.forename: Aliya
authors.initials: A
authors.lastname: Salman
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Balki
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D001416:Back Pain / Q000150:complications / Q000209:etiology; D002574:Cervical Vertebrae; D002585:Cesarean Section / Q000379:methods; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D013595:Syringomyelia / Q000150:complications* / Q000209:etiology; D014911:Whiplash Injuries / Q000150:complications / Q000209:etiology