A case of longitudinally extensive transverse myelitis with an isolated pontine lesion following epidural and spinal anesthesia for cesarean section.
AQP4, anti-aquaporin-4
Autoimmune diseases
CSF, cerebrospinal fluid
DWI, Diffusion-weighted imaging
Epidural anesthesia
Immunotherapy
LETM, Longitudinally extensive transverse myelitis
Longitudinally extensive transverse myelitis
MMT, manual muscle tests
MRI, Magnetic resonance imaging
MS, Multiple sclerosis
NBD, Neuro-Behcet's disease
NMO, neuromyelitis optica
PCEA, Patient-controlled epidural analgesia
POD, Postoperative day
PSL, prednisolone
Pontine lesion
STIR, Short TI-inversion recovery
Spinal anesthesia
TM, Transverse myelitis
Journal
eNeurologicalSci
ISSN: 2405-6502
Titre abrégé: eNeurologicalSci
Pays: Netherlands
ID NLM: 101667077
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
27
05
2020
revised:
03
08
2020
accepted:
12
08
2020
entrez:
5
9
2020
pubmed:
5
9
2020
medline:
5
9
2020
Statut:
epublish
Résumé
Severe neurologic complications following epidural and spinal anesthesia rarely occur. Transverse myelitis has been reported as a rare complication of epidural or spinal anesthesia. We report a case of longitudinally extensive transverse myelitis and an isolated pontine lesion, which responded to immunotherapy. The patient was a 31-year-old pregnant woman who underwent elective cesarean section under epidural and spinal anesthesia. Though the insertions of the epidural and spinal catheters were smooth, she experienced back pain and transient hearing loss during epidural anesthesia. Postoperatively, she exhibited severe motor weakness in both lower extremities, neuralgia below the level of Th10 dermatome, and urinary retention. Magnetic resonance imaging showed longitudinally extensive transverse myelitis from T6 to T10 with a ring-shaped enhanced lesion and an isolated pontine lesion. These findings on magnetic resonance imaging were suggestive of autoimmune diseases such as neuromyelitis optica. The patient was diagnosed with an immunoreactive disease triggered by epidural or spinal anesthesia and was administered high-dose methylprednisolone, which led to the improvement in clinical symptoms. Clinicians should be aware of the possibility of the development of longitudinally extensive transverse myelitis and isolated pontine lesions after cesarean section under epidural and spinal anesthesia.
Identifiants
pubmed: 32885056
doi: 10.1016/j.ensci.2020.100264
pii: S2405-6502(20)30043-5
pii: 100264
pmc: PMC7452523
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100264Informations de copyright
© 2020 The Author(s).
Déclaration de conflit d'intérêts
None.
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