Prolonged post spinal anaesthesia paralysis
The present case has been reported in the Indian Journal of Anesthesia.

A 22-year-old female presented with paraplegia with bowel and bladder involvement. She had undergone lower segment caesarean section 5 days before in a zonal hospital under subarachnoid block (SAB). SAB was administered twice to the patient as the first attempt had partial effect. The surgery was uneventful. Post-spinal anaesthesia, the recovery started around 6 h later with the return of touch sensation.

She was able to move both her legs (grade 1 muscle power) an hour later. Next morning, she complained of loss of touch sensation above the right knee, progressing down and to the left leg as well. Her symptoms deteriorated as there was loss of motor power in both lower limbs. A few hours later, she started experiencing severe intermittent burning pain in legs. Patient was referred to a tertiary care hospital for further management, but the attendants failed to comply and reached the hospital after 5 days of futile alternative therapies.

On examination, other than pallor, the general physical examination was unremarkable, including stable haemodynamics. The central nervous system examination revealed motor power of 0/5 and decreased muscle tone in both the lower limbs. Pan-sensory loss (including loss of vibration sense) was present below 12 th thoracic dermatome; deep tendon reflexes were absent in both lower limbs, and plantar reflexes were mute bilaterally.

Her investigations revealed a total white blood cell count of 15,600/cumm, haemoglobin 6.9 g% and platelet count 4.95 lakh/cumm, prothrombin time 15.8 s, international normalised ratio 1.2, activated partial thromboplastin time 29.9 s and normal liver and renal function tests. Her electrocardiogram and chest X-ray were normal.

The contrast-enhanced computed tomography abdomen was unremarkable. MRI of the spine showed a heterogenous collection in intradural extramedullary space anteriorly from D11 to L2 with the hypointense periphery, suggestive of haematoma, leading to marked spinal canal compromise at these levels.

The patient was subsequently taken up for emergency evacuation of haematoma under general anaesthesia. A clot measuring 3 cm was removed from intradural space after dissecting through compressed spinal membranes.

Post-operative neurological recovery was not favourable with the return of only touch sensation in one leg and flickering movements in both legs. The patient was discharged in the aforementioned condition but lost to follow-up later.

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