Abstract
We report an elderly woman who developed acute severe abdominal pain and bilateral lower extremity paralysis 5 h after an epidural block. Her abdominal symptoms disappeared and her lower-limb strength returned 10 h after the block. Diagnosis was difficult on the day of onset because an MRI revealed no significant compression of the spinal cord, but a subarachnoid hemorrhage was suspected in an arachnoid cyst at the S2 level. Two days after the epidural block, she complained of weakness of the bilateral foot dorsiflex, and an MRI revealed epidural hematoma and spinal cord ischemia at the T11-L1 level. Computed tomography of the brain revealed nominal subarachnoid hemorrhage. We hypothesized that an epidural block would have triggered this kind of insidious hemorrhage and hemorrhagic venous ischemia of the spinal cord.
These neurological damages may be irreversible; therefore clinicians should be aware of these rare complications and the need to perform careful neuroradiological evaluation after an epidural block.
