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Unilateral Epidural Hematoma in a Preeclamptic Post-Partum Patient
Abstract Number: S-52
Abstract Type: Case Report/Case Series
An epidural hematoma is a rare neurologic complication of neuraxial anesthesia with reported incidences ranging from 0.2-3.7 out of 100,000 . We describe a case of epidural hematoma presenting with unilateral neurologic symptoms.
An 18 year old nulliparous and mildly preeclamptic patient presented at 36 6/7 weeks for induction of labor. After obtaining a platelet count (168,000) an L3-4 epidural was placed uneventfully and a bilateral T8 level was attained. Seven hours later, the patient had a left-sided unilateral T10 block. Upon attempt to bolus the catheter, the patient complained of discomfort with aspiration and serosanguinous fluid was noted in the catheter window. The catheter was removed due to suspected intravascular migration. With stable platelets an L2/L3 epidural was then placed without difficulty and a bilateral T8 block was achieved. The patient was comfortable during forceps delivery and episiotomy repair. The epidural was removed two hours later with stable, normal range, platelets and a noted bilateral sensory block.
Twelve hours post-delivery, the patient complained of left sided numbness and weakness with urinary incontinence. Neurologic exam yielded 5/5 right lower extremity and 2/5 left lower extremity motor strength. Rectal tone was absent and there was decreased sensation to pinprick in all dermatomes below T11. Emergent CT showed a T12-L4 left-sided epidural hematoma with marked narrowing of the spinal canal at L2-L3 on the left only. The patient was taken immediately to the operating room for laminectomy and hematoma evacuation. She was discharged home on post operative day 7 with normal neurologic exam.
Though the incidence of epidural hematoma is exceedingly low, providers must remain focused on ruling it out as early diagnosis remains the key to optimal outcome. There are sixteen published cases of epidural hematomas in obstetric patients after neuraxial anesthesia. Eleven of these patients had a known coagulopathy. This case is especially unique because of its unilateral presentation in a parturient with no known coagulopathy or thrombocytopenia. A literature search revealed only one case report of a unilateral epidural hematoma. This case occurred in an 83 year old female with multiple medical problems that had a difficult spinal placement. 
Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetrical regional anaesthesia. Int J of Obstetric Anesthesia.2000; 9: 99-124.
Zink, M., Rath, M., et al. Unilateral Presentation of a Large Epidural Hematoma. Anesthesiology. 2003; 98(4): 1032-1033.