Flaccid Leg Paralysis Caused by a Thoracic Epidural Catheterization: A Case Report

Annals of Rehabilitation Medicine, 2013 · DOI: 10.5535/arm.2013.37.3.453 · Published: June 1, 2013

Simple Explanation

This case report discusses a patient who experienced left leg paralysis after undergoing a thoracic epidural catheterization for post-operative pain management following abdominal surgery. After the surgery, the patient reported sensory losses below T10 and motor weakness in her left leg, leading to further investigation. MRI scans revealed a lesion in the spinal cord, and electrodiagnostic tests indicated nerve root damage. The authors suggest these issues may be related to the epidural catheterization.

Study Duration

Not specified

Participants

A 44-year-old woman

Evidence Level

Level 4; Case Report

Key Findings

1
MRI showed a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level.
2
Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on the left side.
3
Follow-up MRI nine weeks later showed decreased high-signal-intensity lesions and enhanced lesions.

Research Summary

The case report describes a 44-year-old woman who developed flaccid paralysis of the left leg following thoracic epidural catheterization after abdominal surgery. Neurological assessments, MRI, and electrodiagnostic tests indicated a spinal cord lesion and nerve root injuries, potentially caused by the epidural procedure and local anesthetic injection. The patient showed improvement over time with rehabilitation, but continued to experience neuropathic pain.

Practical Implications

Careful Catheter Placement

The report highlights the importance of careful technique during epidural catheterization to avoid direct spinal cord injury.

Neurological Monitoring

Post-operative neurological monitoring is crucial for early detection and management of potential complications like paralysis.

Awake Catheterization

The authors suggest performing epidural catheterization in awake patients to identify potential spinal cord or nerve root penetration promptly.

Study Limitations

1
Single case report limits generalizability.
2
Causation between epidural catheterization and paralysis is presumed but not definitively proven.
3
Lack of a control group to compare outcomes.

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