TY - JOUR T1 - Paraplegia after epidural anaesthesia JF - Practical Neurology JO - Pract Neurol SP - 188 LP - 191 DO - 10.1136/practneurol-2012-000279 VL - 13 IS - 3 AU - Andrés Labiano-Fontcuberta AU - Julián Benito-León AU - Juan Francisco Gonzalo-Martínez Y1 - 2013/06/01 UR - http://pn.bmj.com/content/13/3/188.abstract N2 - A 59-year-old woman presented with 6-week history of recurrent haematuria. Her medical history was unremarkable apart from a 22-pack-year smoking history and hypothyroidism. There was no history of alcohol or drug abuse. Physical examination was normal. An intravenous pyelogram showed a pedunculated tumour in the bladder mucosa, for which she underwent a transurethral resection under spinal anaesthesia. The preoperative clinical and laboratory assessments, including a chest x-ray, were normal, apart from haematuria. Her intraoperative electrocardiogram was normal, her oxygen saturation was >98%, and there were no respiratory symptoms. The biopsy revealed a low-grade papillary urothelial carcinoma. The patient recovered uneventfully from the spinal anaesthetic. However, the next morning, approximately 12 h after the operation, she developed mild leg numbness and could not move her legs. An urgent neurology opinion was requested. She was alert but apathetic. There was marked but painless weakness of both legs with absent deep tendon reflexes and equivocal plantar responses. Pain and temperature sensation were mildly reduced in both legs but vibration and joint position sense were normal. She could urinate and defecate normally. Question 1 What is the differential diagnosis and what would be the most appropriate initial investigation? The patient developed flaccid paraparesis following spinal anaesthesia for resection of a bladder tumour. When evaluating a patient with acute bilateral leg weakness in this setting one should consider the conditions listed in box 1. Box 1 Causes of acute paraparesis Myelopathy   Vascular     Ischaemic: spinal cord infarction     Haemorrhagic     Epidural haematoma (spontaneous or secondary to lumbar puncture)     Haematomyelia (eg, secondary to arteriovenous malformation) Traumatic: Direct needle injury to the cord Neoplastic: Extradural metastases Infective: Epidural abscess Inflammatory Nerve Roots   Cauda equina syndrome    Axonal damage secondary to local anaesthetics    Epidural extension from lumbosacral metastases Acute inflammatory demyelinating polyradiculoneuropathy Cerebral Lesions   Parasagittal lesion Functional (psychogenic) paraparesis Her clinical presentation … ER -