Post Spinal Anesthesia Intramedullary Injury

A young lady 2months after undergoing Caesarean section complaints of both lower limbs weakness with non-specific distribution . In he history, during the epidural anesthesia for caesarean, she experienced severe shooting pain in to the Right lower limb, which resolved with medication. MRI shows longitudinal ill defined cord signal abnormality possibly hydrosyrinx from D11 to conus with no bleed, expansion or arachnoiditis or epidural collections. Submitted by Dr MGK Murthy and Mr Hari Om.

Epidural anaesthesia is one of the safest procedures, but occasional complications are known. This case represents possibly

(i) inadvertent injection of local anesthetic in to low lying variant radiculomeduallry artery branch, feeding the anterior spinal artery , leading to vascular injury

The other possibilities include

(ii) direct intradural administration of LA leading to chemical injury

(iii) direct long needle injury to the cord in high injection

(iv)hypotension injury to the cord during the procedure

(v) post infective sequelae (myelomalacia)

(vi)unusual epidural venous plexus injection leading to venous hypertension and infarction

(vii) unrelated to the procedure and incidental finding due to other causes including trauma, Chiari malformation etc