MagdaTsolaki¹*, Ilias Katsoulas², Efthimios Dardiotis³, Vasileios Siokas⁴, Stelios Christodoulou⁵ and Eleni Arnaoutoglou⁶

¹Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
²Medical school, Aristotle University of Thessaloniki, Thessaloniki, Greece
³Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
⁴Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Greece
⁵Private Hospital Iassos, Larissa, Greece
⁶Department of Anesthesiology, School of Health Sciences, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece

*Corresponding Author: MagdaTsolaki, Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Received: January 02, 2025; Published: January 14, 2025

Abstract

This report presents a case of cauda equina syndrome resulting from toxic arachnoiditis caused by the administration of levobupivacaine with spinal-epidural anesthesia. A 31-year-old woman underwent a cesarean section using combined spinal-epidural anesthesia. However, post-surgery she developed monoparesis of her right lower extremity along with numbness in the same area and saddle-shaped numbness on the right side of her genital area. Subsequent tests including computed tomography of the lumbar and thoracic spine the following day and non-contrast magnetic resonance imaging of the lumbar spine performed five days later did not reveal any abnormal findings. However, contrast-enhanced magnetic resonance imaging of the cervical, thoracic, and lumbar spine after 6 days showed pathological contrast uptake from the meninges in the right lateral part of the conus medullaris and cauda equina roots consistent with arachnoiditis, with no other findings from the spinal cord. The patient was treated with anti-inflammatory treatment with hydrocortisone sodium succinate from the first day and then with high doses of methylprednisolone in combination with a program of physical therapy, kinesiotherapy, and psychotherapy. Despite the above holistic therapeutic approach, 7 years later the patient continued to report weakness and numbness of the lower limb, inability to urinate and defecate, and saddle hypoesthesia in the genital area. Physicians should be aware of the potential neurologic complications of spinal-epidural anesthesia, the potentially toxic role of levobupivacaine in the arachnoid and conus medullaris, and the potential failure of corticoid and physical therapy, although these cases are very rare.

Categories: Anesthesiology, Obstetrics/Gynecology, Neurosurgery.

Keywords: Cauda Equina Syndrome; Cesarian Section; Arachnoiditis; Anesthesia; Levobupivacaine

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Citation

Citation: MagdaTsolaki., et al. “Cauda Equina Syndrome Due to Arachnoiditis After Cesarean Section Under Combined Spinal-Epidural Anesthesia".Acta Scientific Women's Health 7.2 (2025): 13-16.

Copyright

Copyright: © 2025 MagdaTsolaki., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.