Content area
Full Text
Introduction
The decrease in anesthesia-related maternal mortality over the second half of the 20th century is greatly attributed to the increase in neuraxial anesthesia for cesarean delivery (CD) and remains the anesthetic of choice for elective CDs [1,2] . Fortunately, serious and permanent neurologic complications related to the use of neuraxial anesthesia in the obstetric population are rare events [3-6] . The exact incidence of permanent neurologic complications is difficult to determine but has been quoted to be between 0.3 and 1.2 per 100,000 [4] . The etiology of injury includes direct trauma, injection of toxic substances, injection into unintended places, epidural abscess or hematoma, transient neurologic syndrome, and vascular phenomenon [3-5] .
The complication of anterior spinal artery syndrome after neuraxial anesthesia in the obstetrical population is especially rare [3-5] . The exact incidence is difficult to determine, although in a retrospective series of more than 500,000 obstetric patients in the United Kingdom, 1 patient was found to have had anterior spinal artery syndrome after neuraxial anesthesia; and it is uncertain whether epidural anesthesia was the direct cause [6] . Anterior spinal artery syndrome presents as a predominant motor deficit, with or without loss of pain and temperature sensation, and with intact vibration sense and proprioception [4] . Anatomically, a single anterior artery and 2 posterior arteries supply the spinal cord. The anterior spinal artery begins superiorly at the fusion of the vertebral arteries, and radicular arteries support its blood supply distally. The largest and most important of these is the great radicular artery of Adamkiewicz, which arises from the aorta between T9 and L2. Multiple levels of the spinal cord do not receive radicular branches, thus leaving watershed areas that are susceptible to ischemic injury. Often, the etiology is related to severe, prolonged hypotension, arteriosclerosis, or mechanical interference with the aortic blood flow, caused by emboli or vasospasm. Certain types of surgical procedures can predispose or increase the risk of anterior spinal artery syndrome such as surgery to the thoracolumbar aorta or instrumented spine surgery [3,5,7] .
A 32-year-old woman developed persistent neurologic findings consistent with anterior spinal artery syndrome after spinal anesthesia for a primary elective CD.
Case report
The patient provided written informed consent for publication of this report. A...