Cauda Equina Syndrome from Subdural Hematoma after Caudal Epidural Injection

Abstract

Caudal epidural injection (CEI) is commonly used to manage patients with low back or leg pain, but cauda equine syndrome (CES) rarely results from epidural and/or subdural hematoma occurred after the procedure. A 71-year-old man presented at our outpatient department with voiding difficulty and radiating pain in both legs 8 days ago after CEI. The patient also complained pain and numbness of saddle area, CES. He had taken clopidogrel for 8 years after cardiac stent insertion. Lumbar magnetic resonance imaging (MRI) revealed subdural hematoma at the L5-S1-S2 level. The patient underwent urgent surgical treatment for hematoma evacuation. We finally recognized that subdural hematoma in lumbar MRI was found to subdural-extra arachnoid hematoma as considering intraoperative findings. To the best of our knowledge, few cases of this complication have been reported after CEI. Subdural hematoma often is concomitant with subarachnoid hematoma. Subdural and subarachnoid hematoma is associated with poor clinical outcomes due to severe edema of nerve rootlets. However, no evidence of edema and swelling of nerve rootlets was observed during surgery in our case. As a result, the patient achieved full recovery more than we expected unlike the case of subdural and subarachnoid hematoma.