Caesarean delivery complicated by unintentional subdural block and conversion disorder
Hesham Elsharkawy1, Ashish K Khanna2, Sabri Barsoum3
1Anesthesiology Institute and Outcomes Research, Cleveland Clinic Foundation, 9500, Euclid Avenue, Cleveland, Ohio, OH 44195, USA ; Cleveland Clinic Learner College of Medicine of Case Western Reserve University, Cleveland, Ohio, OH 44195, USA.
Case Reports in Medicine
|December 19, 2013
Summary
A rare subdural block during combined spinal epidural labor analgesia complicated a patient who later developed a conversion disorder. This case highlights diagnostic challenges in obstetric anesthesia.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Neurology
Background:
- Combined spinal epidural (CSE) anesthesia is effective for labor analgesia.
- Subdural block is a rare complication of epidural procedures, presenting with patchy sensory/motor deficits.
- Conversion disorder has been associated with neuraxial anesthesia in obstetric patients.
Purpose of the Study:
- To report a unique case of unintentional subdural block during CSE labor analgesia.
- To describe the subsequent development of a conversion disorder in the same patient.
- To highlight the diagnostic complexities arising from overlapping neurological deficits.
Main Methods:
- Case report of a 33-year-old obstetric patient (G4P3) at 40 weeks gestation.
- Inadvertent subdural block during attempted CSE for labor analgesia.
- Post-cesarean delivery observation for neurological symptoms suggestive of conversion disorder.
Main Results:
- The patient experienced an unintentional subdural block during labor analgesia.
- Following an uneventful cesarean delivery, she presented with symptoms of conversion disorder.
- The similar presentation of subdural block and conversion disorder posed diagnostic challenges.
Conclusions:
- This is the first reported case of conversion disorder complicating a subdural block in obstetric anesthesia.
- The overlapping neurological deficits underscore the need for careful clinical assessment.
- This case emphasizes the diagnostic difficulties in managing rare complications of neuraxial anesthesia in obstetrics.
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