Longitudinally extensive transverse myelitis after epidural anaesthesia in childbirth

Abstract

Introduction. Neurological complications related to epidural anesthesia, even though rare, must be promptly diagnosed in order to introduce adequate therapy in time to prevent further progression of the disorder as well as neurological consequences. One of the rare complications of regional anesthesia is longitudinal extensive transversal myelitis (LETM) described in this paper. Case report. A 32-year old patient, who gave birth by Caesarean section in due term, developed LETM the very same day. Considering the neuroradiological findings indicating to the long central lesion in the thoracic and lumbar spine responding as expected to applied immunotherapy (immunosuppressive therapy and therapeutic plasma exchange), it was diagnosed of longitudinally extensive transverse myelitis. Even with all the therapy and regression of the lesions, patient could not stand up without support. Later on in the course of the treatment, according to physiatrician`s opinion, physical therapy was ordered, to which patient had responded slowly but well, by gradually regaining the function of the lower extremities. Conclusion. An early distinction between possible LETM etiologies is crucial in providing an accurate prognosis and guiding therapeutic strategy.