title: A confounding coincidence: epidural anesthesia and paraplegia due to intramedullary tuberculoma in a patient who underwent cholecystectomy.
abstract: BACKGROUND
  Paraplegia associated with epidural anesthesia or caused by intramedullary spinal tuberculoma is rare but catastrophic. We present a case of paraplegia following epidural anesthesia in a patient with an undiagnosed intramedullary spinal tuberculoma.
  
  
  METHODS
  A 42-year-old man developed paraplegia after an open cholecystectomy under epidural anesthesia. Spinal cord infarction, acute transverse myelitis, and intramedullary neoplasms were ruled out by histopathologic examination, and intramedullary spinal tuberculoma at the T6-T7 level was identified. Despite surgical treatment and subsequent antituberculous therapy, the patient retained some disability attributable to the delay in diagnosis.
  
  
  CONCLUSIONS
  Physicians should be aware of coexisting disease as a cause of paraplegia following procedures using epidural anesthesia. Magnetic resonance imaging is the most sensitive diagnostic test, although it is still difficult to differentiate spinal cord infarction, myelitis, intramedullary spinal tuberculoma, and neoplasms from imaging features alone.
authors.affiliation: Department of Anesthesiology, Peking University Third Hospital, Peking University, Beijing, 100191 China.
authors.forename: Changyi
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Rehabilitation, China Rehabilitation Research Center, Boai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068 China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiology, China Rehabilitation Research Center, Boai Hospital, Beijing, 100068 China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000995:Antitubercular Agents / Q000627:therapeutic use; D002763:Cholecystectomy / Q000379:methods; D057210:Delayed Diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010264:Paraplegia / Q000209:etiology*; D014375:Tuberculoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D014399:Tuberculosis, Spinal / Q000150:complications / Q000209:etiology / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents
keywords: Epidural anesthesia; Intramedullary spinal tuberculoma; Paraplegia