A Case Report of Persistent Cauda Equina Syndrome Following Epidural Anesthesia

J Korean Assoc EMG Electrodiagn Med 2009;11(2):151-155.
Published online December 31, 2009.

Abstract

Cauda equina syndrome (CES) is a rare complication of spinal and epidural anesthesia. We report a case of persistent cauda equina syndrome after epidural anesthesia with single shot 0.5% bupivacaine. There was no pain or paresthesia during needle placement or drug injection. 35-year-old woman experienced pain and weakness in the both lower extremities and alterations in bowel and urinary habits after epidural anesthesia for caesarean section. Electrodiagnostic examination revealed asymmetric bilateral lumbosacral polyradiculopathies compatible with cauda equine syndrome. The patient MRI revealed arachnoiditis, but did not show suspicious lesions such as hematoma and abscess. She was treated with medication, bladder training and physical therapy, but her symptoms remained unchanged during a 2 year follow- up. We suggest the chronic adhesive arachnoiditis resulting from bupivacaine neurotoxicity have played a role in producing this devastating chronic complication.

Key Words: Cauda equina syndrome, Bupivacaine, Epidural anesthesia, Chronic arachnoiditis