J Korean Soc Spine Surg.  2009 Jun;16(2):134-137. 10.4184/jkss.2009.16.2.134.

Cauda Equina Syndrome due to Epidural Hematoma After Lumbar Epidural Block : A Case Report

• Ahn BW
• Kim CK
• Yoon JH
• Kim KH
• Lee JH
• Lee EC

• KMID: 2209608
• DOI: http://doi.org/10.4184/jkss.2009.16.2.134

Abstract

Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.

Keyword

Cauda equina syndrome; Lumbar epidural block

MeSH Terms

Aged
Anesthesia, Epidural
Animals
Ankle
Cauda Equina
Dysuria
Emergencies
Follow-Up Studies
Hematoma
Humans
Intervertebral Disc Displacement
Laminectomy
Leg
Magnetic Resonance Spectroscopy
Neurologic Manifestations
Polyradiculopathy
Sensation
Spinal Canal
Spinal Cord
Toes

Figure

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  Fig. 1. (A) Sagital T1-weighted magnetic resonance image shows protruded disc material at L4-L5 and L5-S1 (short arrow) and large epidural lesion (hematoma) showing intermediate high signal, compressing thecal sac at L4-5 anterior epidural region (long arrow) (B) Sagital T2-weighted magnetic resonance image shows large epidural lesion showing mixed high signal.

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  Fig. 2. Axial T1-weighted magnetic resonance image shows that right anterior thecal sac is compressed by epidural lesion at L4-5.

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