Neurological emergency after cesarean section: a case of atypical spinal epidural hematoma
Abstract
Spinal epidural hematoma (SEH) is a rare complication of neuraxial anesthesia. We present a case of a 28-year-old G2P1001 at 28 weeks' gestation underwent an urgent cesarean delivery due to preterm premature rupture of membranes, pre-eclampsia with severe features, and breech presentation. The patient received a spinal anesthetic, which required two attempts. Postoperatively, she developed progressive lower extremity weakness and sensory changes within 48 hours. An MRI revealed a 14 × 10 × 82 mm SEH extending from L3 to S1, necessitating an emergent laminectomy that resulted in favorable outcomes.
We conclude that the anesthesiologists should remain vigilant for SEH, as early detection is vital for optimal maternal outcomes.
Abbreviations: NSVD: Normal Spontaneous Vaginal Delivery, PPROM: preterm premature rupture of membranes, SEH: spinal epidural hematoma, SSS: single shot spinal
Teaching Points:
- Be vigilant for delayed and fluctuating symptoms: SEH can present days to weeks after anesthesia with symptoms like motor weakness or paresthesia that may fluctuate, even without back pain.
- Prioritize early diagnosis with MRI: Any new or evolving neurological symptoms in high-risk patients warrant immediate consideration of SEH. MRI is the diagnostic tool of choice due to its accuracy; CT scans can miss early or small hematomas.
- Prompt surgical decompression is crucial: The best neurological outcomes are linked to early surgical intervention, especially in patients experiencing significant or worsening neurological deficits.
Keywords: Spinal Epidural Hematoma; Epidural Hematoma; Spinal Anesthesia; Epidural Anesthesia; Neuraxial Anesthesia; Labor Epidural; Cesarean Section.
Citation: Boules N, Rahimian R, Dhoon T. Neurological emergency after cesarean section: a case of atypical spinal epidural hematoma. Anaesth. pain intensive care 2026;30(1):129-33. DOI: 10.35975/apic.v30i1.3086
Received: November 11, 2025; Revised: January 04, 2026; Accepted: January 06, 2026
