Acute Transverse Myelitis After Spinal Anesthesia: Should Anesthesia Be Condemned?

Abstract

Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 23-year-old lady developed acute transverse myelitis (ATM) with a rapid progression of acute motor sensory spastic paraplegia and autonomic dysfunction 24 hours after delivery of her first child by caesarean section. Spinal magnetic resonance imaging revealed myelitis at D9-12. She was given 1-gram methyl prednisolone daily for 5 days followed by oral prednisolone 1mg/kg/day which was tapered off in next 3 months. The neurological recovery was fairly good and the patient returned to full time work in 6 months. Since spinal anesthesia had been used in our case, a causal relationship can be assumed. This case emphasizes the danger of attributing all cases of transverse myelitis which have a close temporal relationship to spinal or epidural anesthesia, to the anesthetic technique itself.