Spinal Epidural Hematoma after Epidural Anesthesia in a Patient without Coagulopathy

Abstract

Spinal epidural hematoma with neurological deficits following epidural anesthesia is rare. Risk factors for spinal epidural hematoma included bloody tap, preexisting coagulopathy, and use of anticoagulants. We report a case of spinal epidural hematoma with neurological deficits after epidural anesthesia for laparotomy in a gynecological patient without coagulopathy. The neurological manifestation included lower leg numbness and weakness, urinary incontinence, and positive Barbinski's sign. The radiological finding suggested thoracolumbar spondylosis and disc bulging, and epidural hematoma over T12-L3. The symptoms improved after an emergent laminectomy and removing epidural hematoma was performed. The patient can walk without a walking stick four months later. We suspect that the difficulty during epidural catheter insertion caused the epidural hematoma. The thoracolumbar spondylosis of the patient may contribute to the neurologic deficits caused by the epidural hematoma.