Transient Postpartum Paraparesis Mimicking Guillain-Barré Syndrome Following Labor Epidural Analgesia: A Case Report

Transient postpartum neurological deficits are rare but potentially alarming, sometimes mimicking conditions such as Guillain-Barré syndrome (GBS) and necessitating urgent evaluation to exclude structural, infectious, or inflammatory causes. We report the case of a 25-year-old primigravida with alpha-thalassemia trait who presented at 40+1 weeks for spontaneous labor. She received epidural analgesia without immediate complications but subsequently required emergency cesarean section under general anesthesia for failure to progress. On postoperative day two, she developed bilateral lower-limb numbness, heaviness, and weakness that progressed within hours to quadriparesis. Neurological examination initially showed preserved upper-limb strength with lower-limb weakness, then evolved to reduced motor power in both upper and lower limbs, diminished sensation below T6, and preserved anal tone. The clinical picture raised suspicion for GBS, and she was admitted to the ICU, where her respiratory status was closely monitored; no ventilatory compromise occurred. Extensive workup, including urgent MRI of the whole spine and cerebrospinal fluid analysis on the same day, along with nerve conduction studies within 24 hours, was unremarkable. By postoperative day three, neurological function began to improve spontaneously without specific intervention; full recovery was achieved by postoperative day eight, with no residual deficits on follow-up. This case underscores the importance of a comprehensive, multidisciplinary approach (neurology, neurosurgery, orthopedics, obstetrics, anesthesiology, and intensive care) when evaluating postpartum neurological symptoms. The rapid spontaneous recovery without intervention suggests a transient, self-limiting neurological event, possibly due to neuraxial inflammation or ischemia.