Tarlov cyst with self-healing cauda equina syndrome following combined spinal-epidural anesthesia: a case report

Background Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case presentation A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesi...

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Bibliographic Details
Published in:BMC anesthesiology 2023-10, Vol.23 (1), p.1-352, Article 352
Main Authors: Chen, Zhexuan, Lin, Chuxi
Format: Article
Language:English
Subjects:
Abdomen
Anesthesia
Back pain
Backache
Bladder
Case Report
Catheters
Cauda Equina Syndrome
Combined spinal-epidural anesthesia
Cysts
Electromyography
Epidural
Hematoma
Hemorrhoids
Magnetic resonance imaging
Neurological complications
Neurotoxicity
Risk factors
Ropivacaine
Sacrum
Spinal cord
Sufentanil
Surgery
Tarlov cyst
Ultrasonic imaging
Ultrasound
Urinary incontinence
Urinary retention
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Summary:Background Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case presentation A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. Conclusion This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required. Keywords: Cauda Equina syndrome, Combined spinal-epidural anesthesia, Tarlov cyst
ISSN:1471-2253
1471-2253
DOI:10.1186/s12871-023-02311-w