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Background and Aims Transverse myelitis (TM) is a rare immune-mediated spinal cord disorder. Acute TM during pregnancy is poorly described in the literature and anaesthetic management of these women is still conflicting.
Methods A 28-year-old patient was diagnosed with idiopathic TM at 15-weeks gestation. She had no medical history besides a previous caesarean section (CS) with neuraxial anaesthesia (NA). Symptoms began with paresthesias in the left lower limb and imaging of the spine revealed a medullary lesion at C5.
Results At 39 weeks, she was proposed for an elective CS. She had no neurological symptoms at the time. An epidural anaesthesia was performed by a senior anaesthesiologist at first attempt. A total of 14mL of 0.75% ropivacaine and 10ug sufentanil were administered. There was no sensory block after 20 minutes. The technique was considered failed and a general anaesthesia (GA) was performed, uneventfully.
Conclusions TM has occasionally been attributed to the use of NA and GA. It is also controversial whether patients acutely affected by or recovered from TM are at risk for disease recurrence when NA is administered. Nevertheless, GA is the most reported technique for CS and NA has increasingly been regarded as safe. To our knowledge, this is the first report of NA failure in a patient with history of TM and we cannot discard TM as the reason for failure. This report reaffirms the need for further investigations and the careful consideration of the risks and benefits of NA for CS of women affected by TM.
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