Thoracic epidural catheterization leading to delayed transient neurological symptoms with normal imaging findings

Paraparesis after epidural catheterization is rare but may be multifactorial. We report a case of temporary paraparesis in a 32-year-old female patient after thoracic epidural catheterization performed analgesia. A 16 G epidural needle was introduced at the T(7)-T(8) interspace but as frank blood came through, it was withdrawn and was reinserted at the T(8)-T(9) interspace. An 18 G epidural catheter was introduced and 10 ml of 0.125% bupivacaine with buprenorphine 150 mcg was given. Further top-ups were given for 48 h on complain of pain. There was an episode of hypotension after giving the epidural drug but later on the patient remained haemodynamically stable. On the fourth post-operative day, the patient reported paraparesis with heaviness and tingling sensation in both lower extremities. MRI was normal with no evidence of spinal cord compression, oedema, haematoma or abscess. The patient improved gradually within a period of 3 days. The possible causes of delayed onset of neurological symptoms are discussed.