title: Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia: a case report.
abstract: A 29-year-old pregnant woman was delivered by cesarean section under a combined spinal-epidural anesthesia. Thirty hours after an uneventful surgery, she complained of weakness in her lower extremities and developed fecal and urinary incontinence. Lumbosacral magnetic resonance imaging showed thickening and clumping of cauda equina nerve roots at L2-3 level, consistent with the diagnosis of arachnoiditis. The patient was included in an intense rehabilitation program with a diagnosis of cauda equina syndrome. Most of the symptoms resolved within a few days, but right side foot drop persisted for 2 years after the procedure. Because there was no other etiologies being noticed, we hypothesized that the hyperbaric bupivacaine neurotoxicity was likely to be the cause for this neurologic deficit.
authors.affiliation: Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040 China.
authors.forename: Xiubin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040 China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Xu
authors.affiliation: Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040 China.
authors.forename: Rong
authors.initials: R
authors.lastname: Lin
authors.affiliation: Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040 China. Electronic address: drliuzhq@hotmail.com.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects; D001100:Arachnoiditis / Q000209:etiology; D002045:Bupivacaine / Q000009:adverse effects; D002585:Cesarean Section / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D018908:Muscle Weakness; D020258:Neurotoxicity Syndromes / Q000503:physiopathology; D011128:Polyradiculopathy / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D011247:Pregnancy; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: C section; Cauda equina syndrome; Combined spinal and epidural anesthesia