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 Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 54-55

Postspinal paraparesis


1 Department of Physiology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
2 Department of Anaesthesiology, Burdwan Medical College and Hospiltal, Burdwan, West Bengal, India
3 Department of Gynaecology and Obstretics, Burdwan Medical College and Hospiltal, Burdwan, West Bengal, India
4 Department of Pathology, Burdwan Medical College and Hospiltal, Burdwan, West Bengal, India

Date of Web Publication4-Aug-2012

Correspondence Address:
Arunima Chaudhuri
Department of Physiology, Dr. D. Y. Patil Medical College, Pune - 411018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.99333

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How to cite this article:
Chaudhuri A, Bandopadhyay AK, Hazra SK, Datta S. Postspinal paraparesis. J Obstet Anaesth Crit Care 2012;2:54-5

How to cite this URL:
Chaudhuri A, Bandopadhyay AK, Hazra SK, Datta S. Postspinal paraparesis. J Obstet Anaesth Crit Care [serial online] 2012 [cited 2021 May 10];2:54-5. Available from: https://www.joacc.com/text.asp?2012/2/1/54/99333

Sir,

Undiagnosed cerebral and spinal meningiomas can give rise to grave post anesthetic and postoperative complications. Although extremely rare, paraparesis can be a complication following spinal anesthesia, in a patient with unrecognized spinal tumor. [1],[2]

A 29-year-old Primigravida underwent lower segment ceserean section term for fetal distress under spinal anesthesia. She had regular antenatal check up and all preoperative investigations were within normal limit. She was absolutely well for 3 days following surgery. On the 4th day while she was straining she developed bilateral lower limb weakness. Knee and ankle jerks were exaggerated on both the sides, and plantar reflexes were up going. Decreased sensation below the T10 dermatome with anesthesia in the perineal region, and urine retention were observed. The muscle power in legs was 2/5 bilaterally. MRI showed an ovoid extramedullary intramural mass, ependymoma, in the spinal canal at T10 vertebral level. A neurosurgical operation was performed. Complete resection of the tumor was performed and histopathological examination of the sample was done.

The paralysis of lower limbs gradually improved over two months after surgery and physiotherapy was done and patient recovered after six months.

The intention of publishing this case report is to share the possibility of the existence of meningiomas without any symptoms in the preoperative period in any patient presenting for an elective or an emergency operation. The postoperative morbidity in terms of excessive sedation and coma occurring within 24 h of the operation may be attributed to the anesthetics. Similarly, the occurrence of residual paralysis after administration of spinal anesthetics may be blamed due to the anesthetic technique or the drug unless proved otherwise. [1],[2]

Ependymoma is a rare type of primary brain or spinal cord tumor. Ependymomas represent three to six percent of all CNS tumors. They can occur in both children and adults. For adults, ependymomas account for five percent of adult gliomas with the majority occurring in the spine. [3],[4],[5],[6]

These tumors have rare possibility of being silent for some duration. Spinal cord ependymomas of classic type are usually classified among slow-growing WHO-II grade.

Tumors are characterized by long-term survival. Many cases reported may concern women: the hypothesis of a hormonal mechanism playing a role in the development of the tumor has been suggested. [3],[4],[5],[6]

A prospective study of complications associated with epidural and spinal blockade in obstetrics was carried out during the years 1990 and 1991. 108 133 mothers received epidural blockade and 14856 received spinal blockade. 22% of all mothers received epidural analgesia in labor, and 50% of cesarean sections were performed under either epidural or spinal anesthesia. 128 complications (not including post dural puncture headache) were reported. Of these, 46 were neuropathies involving a single spinal or peripheral nerve. Cardiac arrest occurred twice. Although resuscitation restored normal cardiac function in both cases, one patient was decerebrate and died some days later. The overall complication rate (excluding post dural puncture headache) was approximately 1 per thousand. [7]

Undiagnosed cerebral and spinal meningiomas can give rise to grave post anesthetic and postoperative complications. Careful observation of the postoperative course is essential to exclude any possible neurological complications. If motor and sensory functions do not satisfactorily recover, an MRI examination should be undertaken without delay to determine whether the underlying pathology is treatable or reversible.

 
  References Top

1.Sharma S, Nathani R, Srivastava U. Postoperative manifestations in two cases of undiagnosed meningioma. The Indian Anaesthetists' forum. Available from: http://www.theiaforum.org. [Last accessed on 2006 Oct 1]. Online ISSN 0973-0311.  Back to cited text no. 1
    
2.Dureja J, Singh I, Kad N, Bhai V, Thakur A, Lal J. Paraparesis following spinal anaesthesia in a patient with an undiagnosed spinal tumour. The Indian Anaesthetists' forum. Available from: http://www.theiaforum. org. [Last accessed on 2010 July 3]. Online ISSN 0973-0311.  Back to cited text no. 2
    
3.Hanbali F, Fourney DR, Marmor E, Suki D, Rhines LD, Weinberg JS, et al. Spinal cord ependymoma: Radical surgical resection and outcome. Neurosurgery 2002;51:1162-72.  Back to cited text no. 3
    
4.Szpak GM, Lewandowska E, Schmidt-Sidor B, Pasennik E, Modzelewska J, Stêpieñ T, et al. Giant cell ependymoma of the spinal cord and fourth ventricle coexisting with syringomyelia. Folia Neuropathol 2008;46:220- 31.  Back to cited text no. 4
    
5.Barbagallo GM, Caltabiano R, Parisi G, Albanese V, Lanzafame S. Giant cell ependymoma of the cervical spinal cord: Case report and review of the literature. Eur Spine J 2009;18 Suppl 2:186-90.  Back to cited text no. 5
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6.Landi A, Tarantino R, Marotta N, Rocco P, Antonelli M, Salvati M, et al. Paraganglioma of the filum terminale: Case report. World J Surg Oncol 2009;7:95.  Back to cited text no. 6
    
7.Scott DB, Tunstall ME. Serious complications associated with epidural/spinal blockade in obstetrics: A two-year prospective study. Int J Obstet Anesth 1995;4:133-9.  Back to cited text no. 7
    




 

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