title: Caesarean delivery complicated by unintentional subdural block and conversion disorder.
abstract: Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far.
authors.affiliation: Anesthesiology Institute and Outcomes Research, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, Ohio, OH 44195, USA ; Cleveland Clinic Learner College of Medicine of Case Western Reserve University, Cleveland, Ohio, OH 44195, USA.
authors.forename: Hesham
authors.initials: H
authors.lastname: Elsharkawy
authors.affiliation: Anesthesiology Institute, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, Ohio, OH 44195, USA.
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Khanna
authors.affiliation: Division of Obstetric Anesthesiology, Hillcrest Hospital, Cleveland Clinic Foundation, 6780, Mayfield Road, Mayfield Heights, Ohio, OH 44124, USA.
authors.forename: Sabri
authors.initials: S
authors.lastname: Barsoum