Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
Jin-Sin Women and Children's Hospital, Tainan, Taiwan.
World Neurosurg. 2020 May;137:214-217. doi: 10.1016/j.wneu.2020.01.240. Epub 2020 Feb 10.
Pregnancy is a known risk factor for spontaneous spinal epidural hematoma. During cesarean section or vaginal delivery, the unstable hemodynamic status that may occur owing to fluctuation of intra-abdominal pressure increases the possibility of spontaneous spinal epidural hematoma. During labor and the postpartum period, neurologic symptoms may be masked by labor pain or anesthesia block, which makes early diagnosis difficult, especially in the obstetric clinic without a neurologist or neurosurgeon.
A 28-year-old woman who had a normal spontaneous delivery under epidural anesthesia developed bilateral lower limb flaccid paralysis and loss of sensation 12.5 hours after delivery. Magnetic resonance imaging showed a 5.2 × 0.9 × 2 cm spinal epidural hematoma with severe spinal cord stenosis at the T2-T5 level with no evidence of a vascular anomaly. After emergent evacuation of the spinal epidural hematoma, lower limb muscle power improved from 0/5 to 1/5, and sensation gradually returned to bilateral lower limbs 22 days postoperatively. Deep vein thrombosis developed at 35 days postoperatively, and an inferior vena cava filter was implanted with urokinase infusion for thrombolytic therapy. She was discharged on day 52 after admission, and lower limb muscle power returned to normal after 3 months.
Clinicians should observe postpartum women for signs of myelopathy or back tenderness and closely monitor neurologic function until anesthesia has run its course. A prompt diagnosis can enable prompt intervention.
妊娠是自发性脊柱硬膜外血肿的已知危险因素。在剖宫产或阴道分娩过程中，由于腹内压波动可能导致不稳定的血液动力学状态，增加了自发性脊柱硬膜外血肿的可能性。在分娩和产后期间，由于分娩疼痛或麻醉阻滞，神经症状可能被掩盖，这使得早期诊断变得困难，尤其是在没有神经科医生或神经外科医生的产科诊所。
一位 28 岁的女性在硬膜外麻醉下正常自然分娩，分娩后 12.5 小时出现双侧下肢弛缓性瘫痪和感觉丧失。磁共振成像显示 T2-T5 水平有一个 5.2×0.9×2 厘米的脊柱硬膜外血肿，伴有严重的脊髓狭窄，但没有血管异常的证据。在紧急清除脊柱硬膜外血肿后，下肢肌力从 0/5 提高到 1/5，术后 22 天双侧下肢感觉逐渐恢复。术后 35 天出现深静脉血栓形成，植入下腔静脉滤器并输注尿激酶溶栓治疗。她在入院后第 52 天出院，3 个月后下肢肌力恢复正常。
临床医生应观察产后女性是否有脊髓病或腰痛的迹象，并密切监测神经功能，直到麻醉作用消失。及时诊断可以及时进行干预。
