Neurologic complication following spinal epidural anesthesia in a patient with spinal intradural extramedullary tumor

Abstract

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.

Keywords: Spinal epidural anesthesia; Spinal intradural extramedullary tumor.

Fig. 1

Whole spine magnetic resonance imaging findings. T2-weighted saggital scan shows homogenous low signal mass in T2 vertebra level and no hematoma, except multiple bulging discs in L2/3, L3/4, L4/5, and L5/S1.

Fig. 2

Thoracic spine magnetic resonance imaging findings. Enhanced studies show well demacrated and homogenously enhanced intradural extramedullary tumor in T2 vertebra level (A) and left eccentric tumor mass compressing the spinal cord (B). A : sagittal section. B : axial section.

Fig. 3

Pathologic findings. Histologic section discloses vague whorling pattern of tumor cells and scattered psammoma bodies (A). Tumor cells are usually uniform, with oval nuclei and on occasion intranuclear inclusions (B). A : Hematoxylin and eosin stain, ×100. B : Hematoxylin and eosin stain, ×400.