A Rare Case of Quadriplegia Due to Spinal Epidural Haematoma Following Spinal Anaesthesia

Abstract

Quadriplegia following spinal anaesthesia due to spinal epidural haematoma is a rare but critical complication that usually occurs within 24 hours to a few days of the procedure. I report a case of a 32 year old male who underwent Uretero-Renal Scopy (URS) and double 'J' (DJ) stenting for right ureteric calculus under spinal anaesthesia. The patient was on nonsteroidal anti-inflammatory agents (NSAIDS) and oral Prednisolone for sero-negative rheumatoid arthritis. The preoperative investigations were normal. About four hours after surgery, the patient developed paraesthesia of lower limbs, a little later paraplegia and gradually quadriplegia within 12 to 15 hours of surgery. Magnetic Resonance Imaging (MRI) revealed an extensive spinal epidural haematoma and cord oedema extending from C2 to L5 vertebrae. In consultation with neuro-surgeon, the patient was treated conservatively, while awaiting for the results of coagulation profile, which proved to be Haemophilia. By the end of 2nd and 3rd postoperative day, the upper limbs showed signs of recovery and within a week's time, both the upper limbs regained normal power and tone. The lower limbs showed sensory as well as motor recovery by 3 rd week and about total recovery to normalcy by 6 weeks. Residual paresis remained in left lower limb. The patient was sent for physiotherapy and he recovered completely by 9 months.