Postpartum acute transverse myelitis complicated by epidural analgesia, a case report

Postpartum acute transverse myelitis after epidural anesthesia is uncommon, but this complication is devastating. The relationship between anesthetic procedures and acute transverse myelitis is debatable.

A 34-year-old woman experienced a cesarean section with lumbar epidural anesthesia at a local medical department. According to the patient herself, the process of lumbar puncture was uneven. After she woke up from intravenous anesthesia about 3 h later, she immediately found right lower extremity paralysis, dysesthesia and allodynia. A lumbar spine computed tomography and magnetic resonance imaging study the next day demonstrated subcutaneous emphysema from S1 to T10, an air bubble in the spinal canal between T12 and L1and intramedullary non-gadolinium-enhanced hyper intensity lesion within the cord at the level between T12 and L1 then diagnosed with acute transverse myelitis followed by the several examinations. High-dose IV methylprednisolone (solu-Medrol) pulsed therapy 500 mg Q12H for 4 days following with slowly tapering oral prednisolone was administered and symptoms got improved.

Transverse myelitis may emerge unpredictably following the process of lumbar puncture. If neurologic symptoms are raised after epidural analgesia, we should rule out the most well-known causes of infection, hematoma and use proper diagnostic approaches like CT and MRI as early as possible for diagnosis and management of acute myelitis. Early identification and treatment could minimize the neurologic sequelae.