Resident physician ECU Health Greenville, North Carolina, United States
Case Diagnosis: Communicating hydrocephalus with thoracic cord compression and arachnoiditis
Case Description: A 26 year old female with a history of recent gestation from a 34 week pregnancy due to preeclampsia with epidural placement presented with progressive bilateral lower extremity weakness, double vision, and facial droop after epidural placement for vaginal delivery. Patient recovered well after delivery and epidural removal, however, developed the aforementioned symptoms after discharge. Initial assessment including MRI spine and brain, as well as lumbar puncture, was concerning for communicating hydrocephalus. She was admitted to the Neurosurgical ICU and MRI imaging showed a CSF leak. She underwent a T3-T11 laminectomy, arachnoid cyst fenestration, and drain placement with eventual removal of drain. Deficits discovered on formal ASIA examination classified the patient as a L3 ASIA D.
Discussions: The patient was admitted to inpatient rehab but developed weakness and a headache, prompting a STAT CT Head which showed worsening hydrocephalus. She was urgently transferred to her neurosurgical team who placed a permanent ventriculoperitoneal shunt. The patient was admitted to inpatient rehab afterwards and continued to be a L3 ASIA D, with inconsistent control of bowel and bladder function. Prior to arrival in rehab, the patient had significant difficulty with ambulation and activities of daily living. Upon discharge from inpatient rehab, she was able to ambulate 40 feet with minimal assistance using a rolling walker, and ranged from minimal assistance to contact guard assistance for mobility and activities of daily living.
Conclusions: Given the patient's unique history of a spinal epidural during her complicated labor delivery with spinal cord injury deficits, query is needed to determine if this was a complication from the actual epidural anesthesia or a sequelae of her delivery. Despite the patient's deficits, her overall functional status, including activities of daily living, mobility, and ambulation, were significantly improved after inpatient rehabilitation.
