硬膜外麻酔後の頸部捻転にて発症した頸髄硬膜外血腫の1例

Cervical Epidural Hematoma Caused by Cervical Twisting after Epidural Anesthesia : a case report

I．はじめに

　脊髄硬膜外血腫は様々な原因により発生することが知られている^{1,2,13,17,19,23,24,27,28）}．今回われわれは硬膜外麻酔後と頸椎捻転により生じたと思われる頸髄硬膜外血腫の稀な1例を経験したので若干の文献的考察を加えて報告する．

A case of cervical epidural hematoma caused by cervical twisting after epidural anesthesia was reported.

A 41-year-olcl man who had had anterior fusion of C5-7 using a plate due to cervical spondylosis fif-teen months before admission, had undergone epdural anesthesia through the C7/T1 interspace withoutdifficulty for shoulder pain in a pain clinic. Two hours after injection, he complained of severe pain in hisneck and both shoulders just after cervical twisting as was his custom. Within minutes he noted paresis ofhis left extremities. Neurological examination on admission revealed left side dominant tetraparesis andloss of pain and temperature sensations below the level of T4 on his right side. Laboratory data analysisand coagulation tests were normal. CT scans and MRI demonstrated an epidural hematoma with a small amount of air extending from C3 to the upper margin of C7. Four hours after the onset, a laminoplastywas performed from C3 to C7 with total removal of the hematoma. No bleeding site or any vascular abnor-mality was found to account for the hematoma formation. He was discharged with good recovery after op-eration.

Most of the reported epiclural hematomas associated with epiclural anesthesia were related to coagulo-pathy, anticoagulant therapy or difficult puncture. On review of the literature, this is the first case of spinalepiclural hematoma caused by cervical twisting after spinal anesthesia and which was without impaired coagulation or difficult spinal puncture.

Cervical epidural hematoma should be considered as a possible complication in patients with pain orneurologic-al deficits after some cervical manipulations.