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Anesth Analg 2006;103:513
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000227113.65946.9F

LETTER TO THE EDITOR

Paraplegia from Spinal Cord Injury After Thoracic Epidural Catheterization Performed Under General Anesthesia

Yoshitaka Takii, MD, PhD, Koki Sunouchi, MD, PhD, Masao Tadokoro, MD, PhD, Yujiro Murata, MD, Yoshiko Unno, MD, PhD, Chie Hayano, MD, and Wataru Yoshikawa, MD

Kawakita General Hospital, Tokyo, Japan, sunouchi{at}kawakita.or.jp

To the Editor:

Kao et al. (1) reported an extensive and serious myelopathy caused by an unrecognized intracord catheterization. We report a similar case of a 56-yr-old male patient in whom motor or sensory impairment of the lower extremities occurred after thoracic epidural catheterization was performed under general anesthesia. Magnetic resonance imaging (MRI) revealed extensive intramedullary damage on T2-weighted images from T12 to T4 (Fig. 1). Examination on postoperative day 3 revealed flaccid paraplegia with areflexia, loss of pain and temperature perception, bowel and bladder incontinence, but with preservation of touch and position sensation of both feet. Repeat MRI on postoperative day 22 revealed an atrophic spinal cord below T8 and a small, residual, intramedullary lesion at T8 (Fig. 2).


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  		Figure 1. MRI revealed extensive intramedullary abnormally high signals on T2-weighted images (T2W) from T12 extending upward to T4. A, sagittal view; B, transverse view. (See letter by Takii et al. on page 513).

 

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  		Figure 2. MRI on postoperative day 22 revealed an atrophic spinal cord below T8 and a small residual lesion at ventral T8. (See letter by Takii et al. on page 513).

 

Acute paraplegia after epidural anesthesia is a possible consequence of spinal cord compression, infarction, and trauma. Imaging studies eliminated cord compression that is commonly caused by epidural hematoma, spinal stenosis, or metastatic lesions. Cord trauma due to intracord injection reportedly has distinguished paracentral splitting lesions from hydromyelia on the MRI (2). In our case, the MRI showed an intramedullary air bubble and a long segmental and slitlike lesion, possibly caused by intracord catheterization.

References

  1. Kao MC, Tsai SK, Tsou MY, et al. Paraplegia after delayed detection of inadvertent spinal cord injury thoracic epidural catheterization in an anesthetized elderly patient. Anesth Analg 2004;99:580–3.[Abstract/Free Full Text]
  2. Wilkinson PA, Valentine A, Gibbs JM. Intrinsic spinal cord lesions complicating epidural anesthesia and analgesia: report of three cases. J Neurol Neurosurg Psychiatry 2002;72:537–9.[Abstract/Free Full Text]



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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