title: Transient monoplegia and paraesthesia after an epidural blood patch for a spinal cerebrospinal fluid leak.
abstract: We describe the very rare complication of new onset complete paralysis and numbness of one limb after an epidural blood patch in a 36-year-old woman. Intracranial hypotension resulting from a spinal cerebrospinal fluid fistula may be treated by epidural injection of autologous blood that is, a blood patch. This is usually a safe and effective procedure. The woman's muscle strength of hip flexion, extension, ankle dorsiflexion and plantarflexion decreased from 5/5 to 0/5 following the procedure. After symptom onset, an MRI of her spine showed no compressive or ischaemic lesions amenable to urgent intervention. The cause of neurological deficit was at that time unknown and steroids were administered. Her symptoms persisted for about 2 days and gradually improved. In this paper, the management plan and the course of this rare and alarming complication is reported.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong.
authors.forename: Alvin Ho-Kwan
authors.initials: AH
authors.lastname: Cheung
authors.affiliation: Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong.
authors.forename: Lai-Fung
authors.initials: LF
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
authors.forename: Vincent Ching
authors.initials: VC
authors.lastname: So
authors.affiliation: Department of Anesthesiology, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
authors.forename: May Ka-Mei
authors.initials: MK
authors.lastname: Leung
authors.affiliation: Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong. Electronic address: mattwmlui@netvigator.com.
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Lui
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural / Q000009:adverse effects*; D065634:Cerebrospinal Fluid Leak / Q000150:complications / Q000628:therapy; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D019585:Intracranial Hypotension / Q000209:etiology / Q000628:therapy; D010243:Paralysis / Q000209:etiology*; D010292:Paresthesia / Q000209:etiology*
keywords: Cerebrospinal fluid fistula; Epidural blood patch; Intracranial hypotension