Postpartum bilateral lower-extremity palsy after labor epidural analgesia associated with a spinal epidermoid cyst: a...

Neurologic deficits after neuraxial labor analgesia are rare but require timely evaluation. We describe a multiparous woman who developed new bilateral ankle weakness and distal lower extremity paresthesia six hours after spontaneous vaginal delivery under neuraxial labor analgesia. Analgesia was provided with a dural puncture epidural technique, and two dural puncture epidural procedures were performed because the first epidural catheter was ineffective. No paresthesia or blood aspiration occurred during either procedure, and no motor block was observed during labor. According to our institutional diagnostic pathway for postpartum neurologic deficits, she underwent urgent neurologic assessment and lumbar magnetic resonance imaging, which demonstrated an intradural extramedullary sacral lesion compatible with a spinal epidermoid cyst. Because the deficits were nonprogressive and improving, conservative management was recommended. Motor function had fully recovered by four months; however, localized sensory symptoms persisted at the latest follow-up. This case highlights the value of a standardized escalation pathway for postpartum neurologic deficits after neuraxial labor analgesia. In this patient, prompt magnetic resonance imaging excluded time-critical compressive pathology and identified an uncommon intradural lesion, although the relationship between the lesion and the neurologic deficits remained uncertain.