title: Persistent paralysis after spinal anesthesia for cesarean delivery.
abstract: Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. Spinal anesthesia was easily performed with clear cerebrospinal fluid, and block height was T4 at 5 minutes. Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts.
authors.affiliation: IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Zaphiratos
authors.affiliation: IWK Health Centre, Dalhousie University, Halifax, NS, Canada. Electronic address: dolores.mckeen@iwk.nshealth.ca.
authors.forename: Dolores M
authors.initials: DM
authors.lastname: McKeen
authors.affiliation: IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Bruce
authors.initials: B
authors.lastname: Macaulay
authors.affiliation: IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: George
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000379:methods; D020759:Anterior Spinal Artery Syndrome / Q000139:chemically induced* / Q000150:complications; D002585:Cesarean Section / Q000379:methods; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010243:Paralysis / Q000139:chemically induced*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D004809:Ephedrine
keywords: Adverse outcome; Anterior spinal artery syndrome; Cesarean delivery; Neuraxial anesthesia; Neurologic complication; Paralysis/paraplegia; Spinal anesthesia