ABSTRACT
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis；however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities；however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch；however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.
ABSTRACT
Paraparesis is a rare and serious complication following epidural anesthesia. Abnormal findings on magnetic resonance imaging (MRI) help with the diagnosis；however, diagnosis is challenging in the absence of MRI abnormalities.We present the case of a 26-year-old pregnant woman who received combined spinal-epidural anesthesia for cesarean delivery. The following day, she developed muscle weakness and sensory disturbances in the right lower extremity, which were attributable to the continuous epidural analgesia with ropivacaine that was used during the cesarean delivery. MRI revealed no spinal canal abnormalities；however, skeletal muscle MRI performed in the subacute phase revealed abnormally high signals on T2 and fat suppression T2-weighted imaging in the right paraspinal muscle below the L3 level. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials and sensory nerve action potentials recorded in the lower extremities. After a 4-month period of rehabilitation, the patient could walk independently with a right ankle-foot orthosis and crutch；however, her right leg palsy and sensory disturbances persisted. Here, we report the clinical course of a patient who developed lumbosacral radiculopathy attributable to ropivacaine-induced neurotoxicity. Additionally, we present a review of the literature.