[Permanent paraplegia following epidural and general anesthesia: two case reports]

Case-1: A 72-year-old woman with no past neurological history was scheduled for a rectum resection under general combined with epidural anesthesia. An epidural catheter was introduced at T11-12 interspace without any difficulties. During the operation, she had hypotensive episode needing dopamine, but waked up from anesthesia without any event. When she became alert, she complained muscle weakness and loss of sensation in both lower extremities. On the day after surgery, she became quadriplegic and completely insensitive under Th4 level, but her MRI of the spine showed no abnormal findings. A month after the operation, her MRI showed diffuse spinal degeneration below C4 level and she had flaccid paralysis below Th1 with complete sensory loss below Th7 level. Case-2: A 62-year-old man with no past neurological history was scheduled for gastrectomy under general combined with epidural anesthesia. An epidural catheter was placed via T12-L1 without any difficulty. Operative course was uneventful and awakening from anesthesia was normal. He showed muscle weakness and hypesthesia of lower extremities two hours after the operation, and we stopped continuous injection of epidural anesthesia. His paralysis became worse but MRI of his spine showed no abnormality on the day after the operation. He became complete flaccid paralytic and had complete sensory loss below T7 level. The MRI examination two weeks after the operation showed degeneration below middle thoracic spinal cord. His neurologic symptoms have not improved for two years. The etiology of neurologic deficits of these two case is not obvious although the relation between epidural anesthesia and neurologic symptoms was most likely.