Spinal Epidural Hematoma Following Epidural Anesthesia Managed Safely Without Surgery: A Case Report

The patient, a 27-year-old woman (height, 168 cm; weight, 51.4 kg), had an insignificant medical history with no recent trauma or illness, and she was not taking any medication. Laboratory values revealed that platelet counts, prothrombin time, and activated partial thromboplastin time were normal. No visible signs of coagulopathy were present. She was scheduled for a vaginal radical trachelectomy to treat early-stage cervical cancer. With the patient in the left lateral position, a 19-Ga epidural catheter (Flex Tip plus○R; Epidural Catheter #KM-05500-J, Arrow International, Reading, PA, U.S.A.) was easily placed at the T11/12 level, prior to induction of general anesthesia. However, soon after placement of the epidural catheter, she experienced slightly reduced sensation in both lower extremities (Frankel Grade [1] D). A test dose injection of 1% lidocaine (3 mL) with 1/100,000 adrenaline, following negative aspiration for blood or Cerebral Spinal Fluid (CSF), induced loss of voluntary movement in both lower extremities and a clear sensitivity to a pinprick at the T6 level (Frankel Grade B). The patient was neither distressed nor drowsy and had no papillary changes or ventilator difficulty, and her vital signs were stable. Intrathecal catheter placement was suspected, despite CSF being aspirated through the catheter. Because the ferromagnetic catheter, which was composed of a combination of medical grade polyurethane and inner stainless steel coil wire, might interact with the magnetic field during subsequent Magnetic Resonance Imaging (MRI), the epidural catheter was removed (Figure 1 and 2).