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Abstract
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Background and Aims Spinal epidural hematoma is a rare but potentially devastating complication of regional anesthesia. Symptomatic SEH accounts for less than 1% of all spinal space-occupying lesions and affects only 1 per 1 million people annually. The incidence of SEH after neuraxial anesthesia has historically been approximated to be less than 1 in 220,000 patients. We report a case of SEH, to highlight the importance of early diagnosis and surgical intervention.
Methods An 85-year-old patient underwent surgery to repair a medial malleolus fracture, under general anesthesia, after multiple unsuccessful attempts for subarachnoid anesthesia. Past medical history included hypertension, dyslipidemia, hypothyroidism, and lumbar stenosis. On the 2nd postoperative day, she presented with muscle weakness, followed by paraparesis and impaired sensation of the lower limbs bilaterally. The magnetic resonance imaging (MRI) revealed a spinal epidural hematoma compressing the spinal cord toward the L1 vertebral body. On the same day, the patient underwent surgical spinal decompression.
Results Immediately postoperatively, the patient showed neurological improvement as evidenced by symptoms and imaging improvement and followed rehabilitation protocol. After 3 months follow up, she is discharged from hospital and able to walk with help.
MRI: L1 spinal epidural hematoma
Postoperative MRI
Conclusions Anesthetists and surgeons, as a team must be alert for the possibility of SEH whenever neurological symptoms occur in the postoperative period, especially after a neuraxial blockade which can be connected to this complication. MRI is the preferred diagnostic method and early surgical intervention is associated with optimal neurological outcomes.