It was found that power in the left lower limb (LL) 1/5 and right LL 2/5 [Table 1].
Next morning, patient's bilateral LL powers became normal (5/5). Damage to nerve roots of cauda equina following spinal anesthesia may occur due to compression caused by hematoma, inflammation, stretching due to abnormal position, direct trauma, and spinal ischemia or as a result of neurotoxicity of local anesthetics.
While discharging after 3 days, we referred the patient to hematologist and neurosurgeon for further evaluation. Spinal hematoma following lumber puncture is associated with clotting disorders, either acquired (anticoagulant treatment) or congenital (hemophilia) or bleeding from a tumor or vascular malformation within the spinal canal.
Arun Mathur Department of Anaesthesia and Critical Care, Kannur Medical College, Anjarakandy P.
O, Kannur - 670 612, Kerala India Source of Support: None, Conflict of Interest: None Subarachnoid block (SAB) is an extensively used regional anesthesia technique for many surgeries.
The complication was noticed early and managed conservatively with a high dose of intravenous steroid and improved drastically in a short period.
Keywords: International normalized ratio, methylprednisolone, postspinal neurological complication, thalassemia, vigilant monitoring How to cite this URL: Mathur A, Nagappa C V.In the absence of neurosurgeon and functional magnetic resonance imaging (MRI), we decided to shift the patient to a higher center for further management.Meanwhile, we started injection methylprednisolone 1.8 g infusion over 30 min followed by 324 mg/h, injection tranexamic acid 600 mg over 5 min and injection Vitamin K 10 mg. Surprisingly, patient's power improved between 1/5 to 2/5 in the left LL and 2/5 to 3/5 in the right LL in 2 h of starting steroids.As MRI was unavailable hematoma could not be confirmed.The basic treatment for spinal hematoma is surgical decompression.Transient neurologic syndrome as differential diagnosis ruled out as it is exclusively a pain syndrome, as pain was present prolonged effect of block was also negated.Abnormal INR, sign, symptoms, examination findings, and blood tinged CSF at repeated lumber punctures goes in favor of hematoma causing CES.The most likely causes in our case could be hematoma, trauma or neurotoxicity to nerves leading to CES.As patient complained of back pain and leg pain postoperatively and examination revealed sensory and motor deficit.Neurological complications are rare following spinal anesthesia.We are reporting neurological complication in a patient the following appendectomy under SAB with unsuspected coagulopathy.