Transient paraplegia due to subarachnoid haemorrhage following spinal anaesthesia

Abstract

Spinal subarachnoid haemorrhage is a rare complication of spinal anaesthesia, especially following atraumatic lumbar puncture and in the absence of coagulopathies. The initial presentation of spinal subarachnoid haemorrhage is variable and paraplegia with full recovery within a few hours is rare. Bleeding can extend into the intracranial subarachnoid space, but there are only a few reports of symptomatic intracranial and spinal subarachnoid haemorrhage after spinal anaesthesia. We report co-existing spinal subarachnoid haemorrhage and intracranial subarachnoid haemorrhage after atraumatic spinal anaesthesia in a 69-year-old woman without a coagulopathy. The day after surgery she developed flaccid paraplegia that spontaneously resolved in a few hours. Magnetic resonance imaging demonstrated subarachnoid high signal intensity from T11-S2, consistent with spinal subarachnoid haemorrhage. On the same day the patient complained of severe headache which was later followed by diplopia. Neurological imaging studies revealed diffuse distribution of blood in the subarachnoid space but no intracranial vascular malformations. At the time of diagnosis spontaneous recovery of spinal symptoms had already begun and the clinical manifestations eventually resolved with conservative management. The possibility of an intracranial haemorrhage should always be considered when spinal subarachnoid haemorrhage is identified, even in cases of uncomplicated spinal anaesthesia in patients with no known risk factors for spinal haemorrhage.

Acute paraplegia after aneurysmal subarachnoid hemorrhage: Case report of a rare complication with a 2‑year follow‑up

“…There is a small number of reports of acute paraplegia secondary to hemorrhage ( 3 , 4 ). It has also been reported that subarachnoid hemorrhage after spinal anesthesia causes paraplegia ( 5 ). The present case report describes the preoperative and postoperative conditions and postoperative recovery of a patient with acute paraplegia following a ruptured aneurysm.…”

Novel presentations, rare complications and educational content: cases in clinical practice

“…A more feared complication of neuraxial anaesthesia is bleeding, particularly in coagulopathic or anticoagulated patients. Olivei et al remind us that even in the absence of altered coagulation, clinically significant bleeding is possible during apparently atraumatic spinal injection [3]. They report a subarachnoid haemorrhage of possible lumbo‐spinal origin, which resulted in a transient flaccid paraplegia that spontaneously and completely resolved within hours.…”