title: Urinary retention occurring one week after spinal anesthesia: a case of Elsberg syndrome.
abstract: OBJECTIVE
  We describe a case of urinary retention caused by viral sacral myeloradiculitis (Elsberg syndrome) that occurred one week after spinal anesthesia. The differential diagnosis of urinary retention after spinal anesthesia is discussed.
  
  
  METHODS
  A 76-yr-old male patient presented for operative removal of a right testicular hydrocele under spinal anesthesia. Anesthesia and surgery were uneventful, and he was discharged on the fifth postoperative day. Two days after discharge, he developed intermittent anal pain and voiding difficulty and was readmitted to hospital on the tenth postoperative day. He subsequently developed urinary retention, incontinence of feces, and difficulty in defecation. Magnetic resonance imaging showed no epidural hematoma, abscess, or other lesions in the spinal column, cauda equina, or spinal cord. Neurological examination showed dysesthesia in the perineal region and loss of the anal reflex and bulbocavernosus response, which indicated sacral (S4-5) radiculopathy or a lesion of the conus of the spinal cord. A cerebrospinal analysis showed slight elevation of protein without pleocytosis. After neurologic consultation, herpetic sacral myeloradiculitis was suspected and intravenous acyclovir was administered along with large doses of methylprednisolone and immunoglobulin. The symptoms gradually resolved, and the difficulty in voiding resolved 19 days after initiation of the treatment. The patient was discharged 23 days after the start of the treatment without any other complications.
  
  
  CONCLUSIONS
  This case suggests that Elsberg syndrome is important in the differential diagnosis of urinary retention after spinal anesthesia and should be discriminated from other anesthesia-related complications.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization, Kure Medical Center, Chugoku Cancer Center, Aoyamacho 3-1 Kure-shi, Hiroshima, 737-0023, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Fujii
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Moriwaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Torii
authors.forename: Ken
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Shiroyama
authors.forename: Minoru
authors.initials: M
authors.lastname: Tajima
authors.forename: Mikako
authors.initials: M
authors.lastname: Sanuki
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Kurita
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000379:methods; D003937:Diagnosis, Differential; D006566:Herpesviridae Infections / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D013997:Time Factors; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology*
chemical_list: D007136:Immunoglobulins; D000212:Acyclovir; D008775:Methylprednisolone