Spinal Epidural Hematoma with Cephalad Neurological Manifestations Following Lower Thoracic Epidural Catheter Removal...

Spinal epidural hematoma (SEH) is a rare but potentially serious complication of neuraxial anesthesia that may result in irreversible neurological damage. While symptoms often localize to the site of catheter insertion, hematomas may occasionally occur at distant levels, complicating diagnosis. We report the case of a 66-year-old woman who developed a thoracic SEH following the removal of an epidural catheter placed for postoperative analgesia after laparoscopic nephrectomy. The patient, with no predisposing risk factors, experienced sudden onset of severe back and neck pain, followed by rapidly progressing sensory and motor deficits involving both upper and lower extremities. Notably, neurological symptoms were localized cephalad to the catheter insertion site. An immediate CT scan revealed an epidural hematoma extending from T3 to T6. An MRI was also ordered. However, prior to MRI, the patient's symptoms resolved spontaneously within one hour without surgical intervention. She was closely monitored, and no recurrence occurred. The patient was discharged on postoperative day 16 without neurological sequelae. This case underscores the importance of considering SEH in patients who develop new neurological symptoms following epidural catheter removal, even when symptoms arise at levels remote from the catheter site. Prompt multidisciplinary evaluation and early imaging are essential to guide appropriate management and prevent permanent neurological injury.