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BJA Advance Access published online on October 8, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem265
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Spontaneous spinal epidural haematoma: a rare cause of quadriplegia in the post-partum period

S. Bose, Z. Ali, G. P. Rath and H. Prabhakar*

Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110029, India

* Corresponding author. E-mail: prabhakarhemanshu{at}rediffmail.com

Spontaneous spinal epidural haematoma (SSEH) is a rare cause of neurological deficit in the pregnant and post-partum patients. However, SSEH with associated myelitis presenting as quadriplegia and respiratory paralysis in the post-partum period has never been reported. We report the development of acute onset quadriplegia progressing to respiratory arrest in a 24-yr-old woman 2 weeks after normal vaginal delivery. There was no history suggestive of any coagulopathy (inherited or acquired), eclampsia, pre-existing neurological deficit, or iatrogenic manipulations such as spinal/epidural injections. Magnetic resonance imaging revealed a posterior epidural haematoma extending from C4–C7 and areas of signal changes in spinal cord from cervicomedullary junction to D5 level (suggestive of demyelination). We highlight this rare cause of quadriplegia; focusing on the altered dynamics of the epidural vasculature in the peripartum period leading to SSEH.

Keywords: complications, epidural haematoma; complications, quadriplegia; complications, neurological; pregnancy


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