PP10.7 - 2603: A spinal cord injury after epidural anesthesia: An idiosyncratic reaction

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• 作者：T.H. Yeo ; K. Forbes
• 刊名：European Journal of Paediatric Neurology
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：19
• 期：supp_S1
• 页码：S71
• 全文大小：80 K

文摘

Regional anaesthesia is associated with reduction in mortality and serious complications in comparison with general anaesthesia. Spinal cord injuries associated with epidural anaesthesia in children is limited to a few case reports. We aim to describe a paediatric case of spinal injury associated with epidural anaesthesia and its possible causes.

Case review and results

12 years old girl with Ohdo syndrome had lumbar epidural anesthesia performed under general anesthesia for her abdominal surgery. The epidural needle was introduced a T11 and T12 interspace without any complication. 20hr post surgery, she developed sensory disturbance below T11 and paraparesis with no movement of lower extremities. Her ASIA impairment scale is B (Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5). MRI spine revealed focal area of non-specific T2 signal abnormality within the spinal cord at the level of T11. Day2 MRI spine showed that the abnormal T2 signal extended from T10 to T12. No radiological evidence of haemosiderin deposition to suggest traumatic injury to spinal cord, abscess formation, or vascular abnormalities. The radiological appearance was not typical for an autoimmune process or demyelination. Extensive investigations including inflammatory, metabolic and autoimmune markers, e.g. anti-NMO and anti-MOG, were all negative. Further pharmaceutical and manufacturer's investigations excluded technical problems with epidural pump, epidural bolus and infusion solutions. MR imaging after 3 months showed focal myelomalacic changes at T11. Despite intensive spinal rehabilitation, she has residual spastic paraparesis (GMFSC level 3). Her bladder and bowel dysfunction resolved 3 months later.

Conclusion

This is one of a few reported paediatric cases of spinal cord injury after non-traumatic epidural injections. After exclusion of other causes of spinal cord injuries, idiosyncratic reaction related to epidural anesthetic agent is the most likely diagnosis; and identifying those patients at risk remain uncertain.