Acute Transverse Myelitis Following Spinal Anesthesia: A Case with Systemic Lupus Erythematosus

Öz

Objective: Spinal anesthesia is a widely used and safe technique in surgical practice. However, although rare, it may cause serious neurological complications. One of these is acute transverse myelitis(ATM). Materials and Methods: A 45-year-old woman with a known diagnosis of systemic lupus erythematosus (SLE) underwent a transobturatortape(TOT) procedure under spinal anesthesia. Results: Twenty-four hours after the operation, she developed sensory loss starting at the T8 level and urinary retention. Spinal MRI revealed no pathological findings, and cerebrospinal fluid analysis was normal. Based on the clinical evaluation, autoimmune-related transverse myelitis was considered. The patient was treated with intravenous methylprednisolone (1 g/day for 10 days). Following steroid therapy, her symptoms significantly regressed. Discussion and Conclusion: In this case report, the clinical presentation, diagnosis, and treatment process of acute transverse myelitis developing after spinal anesthesia in a patient with SLE are discussed.

Anahtar Kelimeler

• Spinal anesthesia
• transverse myelitis
• systemic lupus erythematosus
• neurologicalcomplication

Destekleyen Kurum

No funding.

Etik Beyan

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.

Kaynakça

1. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, et al. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97(5):1274-80.
2. Suchett-Kaye AI. Acute transverse myelitis complicating pneumonia. Lancet.1948;255(6497):417.
3. Beh SC, Greenberg BM, Frohman T, Frohman EM. Transverse myelitis. NeurolClin. 2013;31(1):79-138.doi:10.1016/j.ncl.2012.09.008
4. Seok JH, Lim YH, Woo SH, Yon JH. Transverse myelitis following combined spinal-epidural anesthesia. Korean J Anesthesiol. 2012;63(5):473-4.
5. Shimada T, Yufune S, Tanaka M, Akai R, Satoh Y, Kazama T. Acute transverse myelitis arising after combined general and thoracic epidural anesthesia. J A Clin Rep. 2015;1(1):4.
6. Defresne P, Hollenberg H, Husson B, Tabarki B, Landrieu P, Huault G, et al. Acute transverse myelitis in children: clinical course and prognostic factors. J Child Neurol. 2003;18(6):401-6.
7. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG. Plasma exchange for severe attacks of CNS demyelination: predictors of response. Neurology. 2002;58(1):143-6.
8. Krishnan AV, Halmagyi GM. Acute transverse myelitis in SLE. Neurology.2004;62(11):2087.