[Transient paraplegia due to epidural hematoma after catheter withdrawal]

Abstract

A 58-year-old man with hypertension underwent laparoscopic distal gastrectomy under general and epidural anesthesia. Preoperative laboratory date revealed a normal platelet count and normal coagulation profile. Epidural puncture was successfully performed at the T9-10 intervertebral space on the first attempt without bleeding. An epidural catheter was smoothly inserted 5 cm cephalad. On the third postoperative day, paraplegia due to thoracic epidural hematoma developed shortly after extraction of the catheter. At that time, his blood pressure was 190/102 mmHg because of a pain due to walk. On using a hypotensive drug, his blood pressure fell. Ten minutes later, paraplegia disappeared spontaneously. It is suggested that the spinal cord of the patient was subjected to transient pressure hematoma. A decline in blood pressure may have caused the blood to spread through the epidural space, such that the neurologic symptoms disappeared.