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Spinal cord infarction following epidural and general anesthesia: a case report

Overview of attention for article published in JA Clinical Reports, August 2017
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Title
Spinal cord infarction following epidural and general anesthesia: a case report
Published in
JA Clinical Reports, August 2017
DOI 10.1186/s40981-017-0109-2
Pubmed ID
Authors

Kaori Kobayashi, Noriko Narimatsu, Takafumi Oyoshi, Takashi Ikeda, Toshimitsu Tohya

Abstract

Epidural anesthesia is widely used for postoperative analgesia and rarely causes permanent neurological complications. We report a case of paraplegia following abdominal surgery under combined epidural/general anesthesia. A 75-year-old woman underwent a scheduled abdominal total hysterectomy and bilateral salpingo-oophorectomy for suspected endometrial cancer. In the operating room, an epidural catheter was inserted at T11/12 while the patient was conscious. The needle entered smoothly, with no observed bleeding, paresthesia, or pain, and general anesthesia was induced. During surgery, 4 mL of 0.25% levobupivacaine and 0.1 mg of fentanyl were administered via the epidural catheter, and a solution of 2.5 μg/mL fentanyl and 0.2% levobupivacaine was continuously infused at 4 mL/h for postoperative analgesia. The patient promptly regained consciousness and could move her bilateral lower extremities without difficulty upon leaving the operating room. During the first postoperative night, she complained of an absence of sensation and weakness in the lower extremities. By the morning of the second postoperative day, she had developed paralysis and sensory losses associated with touch, temperature, pinprick, and vibration below T5. The epidural infusion was stopped. Magnetic resonance imaging (MRI) revealed a hyperintense area of the thoracic cord from T8 to T11, and spinal cord infarction was suspected. Ossification of the yellow spinal ligaments between T11 and T12, resulting in thoracic canal stenosis and thoracic spinal cord compression, were observed. Notably, the epidural catheter was inserted at the same site where the thoracic canal stenosis was present. Permanent neurological complications of epidural anesthesia are rare. Studies of neurological complications after epidural/spinal anesthesia have noted the possibility of spinal anomalies, such as lumbar stenosis, in relation to neurological complications after epidural/spinal anesthesia. In this case, the onset of spinal cord infarction may have occurred coincidentally with catheter insertion into the site of existing spinal stenosis. Therefore, it is important to evaluate lower extremity symptoms and consider spinal disease before administering epidural anesthesia. Spinal cord infarction may be prevented by preoperatively identifying spinal lesions using computed tomography or MRI in cases of suspected spinal disease.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 31 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 31 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 5 16%
Librarian 2 6%
Student > Postgraduate 2 6%
Student > Doctoral Student 2 6%
Student > Bachelor 2 6%
Other 8 26%
Unknown 10 32%
Readers by discipline Count As %
Medicine and Dentistry 16 52%
Mathematics 1 3%
Unspecified 1 3%
Unknown 13 42%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 August 2017.
All research outputs
#8,731,607
of 13,930,577 outputs
Outputs from JA Clinical Reports
#6
of 26 outputs
Outputs of similar age
#156,494
of 269,274 outputs
Outputs of similar age from JA Clinical Reports
#1
of 1 outputs
Altmetric has tracked 13,930,577 research outputs across all sources so far. This one is in the 24th percentile – i.e., 24% of other outputs scored the same or lower than it.
So far Altmetric has tracked 26 research outputs from this source. They receive a mean Attention Score of 1.1. This one scored the same or higher as 20 of them.
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