Cervico-Thoracic Intradural Extramedullary Lipoma

A 42-year-old female was admitted with an 11-month history of progressive spastic paraparesis and ataxic gait. Magnetic resonance imaging showed intraspinal space occupying lesion compressing the spinal cord posteriorly, located from C5 to T2 with iso to high signal intensity at T2-weighted images and high signal intensity at T1-weighted images. The patient underwent surgery for decompression of the affected spinal cord because of the progressive neurological deficit. At surgery, the lesion was intradural extramedullary lipoma composed with mature adipose tissue. Partial tumor removal to decompress the neural structures and laminoplasty to avoid postoperative instability and deformity were performed. Postoperatively, she demonstrated improvement in paraparesis and was able to walk without assistance. Though attempts to decrease the size of or even to totally remove a lipoma are not required to achieve satisfactory results and carry considerable risks of surgical morbidity, a careful and limited decompression of the affected spinal cord through a partial removal of the tumor and laminoplasty could result in a significant neurological improvement.

Transient Neurological Syndrome after Bupivacaine Spinal Anesthesia: A case report / 대한마취과학회지

Transient neurological syndrome often occurs after spinal anesthesia with lidocaine, but relatively infrequently with bupivacaine. We describe a case of transient neurological syndrome, which occurred after spinal anesthesia with 15 mg of 0.5% bupivacaine. Transurethral resection of the bladder was performed in the lithotomy position. There were no problems during the spinal anesthesia and surgery. However, the first day after surgery, the patient complained of paresthesia and pain over the L4-5 dermatomes in both legs, but without decrease of muscular strength. The senses in this area returned to normal over the following 2 weeks. Even though this one case of a patient with transient neurological syndrome after bupivacaine spinal anesthesia is reported, the authors still consider bupivacaine relatively safe for spinal anesthesia.