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Anesth Analg 2005;101:1212-1214
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000175764.16650.85

REGIONAL ANESTHESIA

Can Direct Spinal Cord Injury Occur Without Paresthesia? A Report of Delayed Spinal Cord Injury After Epidural Placement in an Awake Patient

Ban C. H. Tsui, MD, MSc, FRCP(C)*, and Kevin Armstrong, MD, FRCP(C){dagger}

*Department of Anesthesiology and Pain Medicine University of Alberta, Edmonton, Alberta, Canada, and {dagger}Department of Anesthesia, University of Western Ontario, London, Ontario, Canada.

Address correspondence and reprint requests to Ban C.H. Tsui, MSC, MD, FRCP(C), Department of Anesthesiology and Pain Medicine, 8–120 Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2G3. Address e-mail to btsui{at}ualberta.ca.

We discuss the etiology of a delayed spinal cord injury after epidural anesthesia without paresthesia. The description of such a case in an awake, adult patient who underwent a Whipple resection is provided. An epidural was performed at approximately the T8-9 interspace with the patient in the sitting position after 1 mg of midazolam was administered. On the first attempt, a dural puncture occurred. The patient did not report any paresthesia or pain. The needle was withdrawn and a second attempt was made one interspace lower. At this level, the epidural catheter was advanced into the epidural space uneventfully. Postoperatively, the patient suffered decreased motor function in the right leg. Magnetic resonance imaging revealed high signal intensity within the spinal cord, indicating cord edema compatible with direct needle trauma. An extradural fluid collection consistent with a hematoma was also noted. Although it may be impossible to confirm if the spinal cord injury was a result of direct needle trauma, hematoma, or a combination of needle trauma and hematoma, these events clearly raise the important question of whether an awake patient will always report paresthesia secondary to spinal cord trauma.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.