Outcomes of cell infusion for the treatment of neurological sequelae induced by spinal anesthesia-associated subdural hematoma: A case report

Abstract

Background: Subdural hematoma following spinal anesthesia for cesarean delivery is a rare complication. Surgical removal of the hematoma is the standard treatment. However, there are still many patients who suffer permanent nerve damage of varying degrees after surgery. Cell therapy has recently shown great potential for treating nerve damage.

Case presentation: This report described a case of paraplegia due to an epidural hematoma occurring after spinal anesthesia for cesarean section. The patient underwent surgery to remove the hematoma and rehabilitation afterward. However, no improvement was noted. Paralysis of the lower extremities associated with urinary retention and constipation persisted. The patient received three administrations of cell infusion: the first time with autologous bone marrow-derived mononuclear cells and the following two with autologous adipose mesenchymal/stromal cells. After three cell infusions, the patient was able to walk and could urinate and defecate voluntarily. Sensory and motor function were improved and MRI showed a decrease in adherence of the nerve roots and spinal cord.

Conclusions: Our results demonstrated that cell therapy may ameliorate paralysis of the lower extremities as well as fecal and urinary function following spinal hematoma associated with spinal anesthesia.

Keywords: Cell therapy; Mesenchymal stem cell; Paralysis; Regional anesthesia; Spinal hematoma.

Fig. 1

Timeline of the case presentation description.

Fig. 2

MRI scan and urodynamic investigation of the patient before cell infusion. (A) Preoperative MRI scan of the patient on August 18th, 2020 with a representative axial T2W FFE 3D (left panel) and a representative sagittal T2W image (right panel). (B) Postoperative MRI (T2-tse-sag) conducted before administration of cell therapy to the patient on October 1st, 2020 with a representative axial CISS image at the level of vertebra L2 (left upper panel), a representative axial CISS image at the level of vertebra L3 (left lower panel), and a representative sagittal T2W image (right panel). (C) Urodynamic investigation of the patient before cell infusion.

Fig. 3

MRI scan, urodynamic investigation, and motor and sensory function of the patient after cell treatment. (A) Spinal MRI scan of the patient after the 2nd cell infusion on January ^11th, 2022 with a representative axial CISS image at the level of vertebra L2 (left upper panel), a representative axial CISS image at the level of vertebra L3 (left lower panel), and a representative sagittal T2W image (right panel). (B) The motor and sensory function of the patient. (C) Urodynamic investigation of the patient after the 2nd cell infusion.