Abstract
Acute transverse myelitis after surgery is a rare condition, but this complication is devastating. The relationship between anesthetic procedures and acute transverse myelitis is controversial. A 46-year-old woman was scheduled a colostomy closure, and general anesthesia with thoracic epidural anesthesia was performed. Epidural catheter was inserted at the T10–11 interspace, and insertion was smooth, and no blood or cerebrospinal fluid leakage was seen. However, 28 h after the surgery, the patient complained motor, sensory, and autonomic dysfunction. Two days after onset, a magnetic resonance imaging study demonstrated intramedullary hyperintensity, particularly in the gray matter, extending from T5–T9 and then diagnosed with acute transverse myelitis followed by the several examinations. High-dose IV methylprednisolone treatment was initiated and neurologic function restored 2 months after onset. Transverse myelitis may unpredictably occur following surgery. We are not able to determine the pathogenic relationship between anesthesia and myelitis with certainty, but proper diagnostic approach to myelitis may improve the prognosis.
Highlights
Severe neurologic complications following postoperative epidural analgesia occur infrequently or rarely with a reported prevalence of only 0.005–0.070 % [1]
Most recognized are epidural hematoma or abscess, whereas no systematic reviews, which show the relationship between anesthetic procedures or medications and acute transverse myelitis, have been published, and only few cases of acute myelitis after thoracic epidural anesthesia have been reported [2, 3]
We present a patient who postoperatively developed acute myelitis with an epidural catheter in situ
Summary
Severe neurologic complications following postoperative epidural analgesia occur infrequently or rarely with a reported prevalence of only 0.005–0.070 % [1]. We present a patient who postoperatively developed acute myelitis with an epidural catheter in situ. An emergent thoracolumbar spine magnetic resonance imaging (MRI; 1.5T system, Ingenia, Philips Medical Systems, Best, The Netherlands) demonstrated intramedullary hyperintensity, in the gray matter, extending from T5–T9 on T2-weighted and diffusion-weighted MR images (Fig. 1). No spaceoccupying lesion, such as hematoma or abscess, and no intracranial lesion, such as hemorrhage or infarction, were seen. Forty-nine days after onset, thermal nociception and hyperesthesia had diminished ( incompatibility still existed) and bladder and rectal disturbance had recovered. Fifty-one days after onset, results of MMTs were 5/5 for iliopsoas and hamstrings; she could walk without a cane
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
