Last update:
29-Sep-2025

Spinal epidural hematomas (SEH) are rare but serious complications of regional anesthesia, particularly neuraxial techniques. With an annual incidence of one per one million people and occurring in less than 1% of spinal spaceoccupying lesions, SEH remains a critical concern due to its potential for severe neurological impairment. This case report highlights an 85-year-old woman who underwent surgery for a medial malleolus fracture under general anesthesia after unsuccessful subarachnoid anesthesia attempts. Past medical history included hypertension, dyslipidemia, hypothyroidism, and lumbar stenosis. On the second day post operatively, paraparesis and sensory loss were documented in both lower limbs. Magnetic resonance imaging (MRI) revealed a SEH compressing the spinal cord at the L1 vertebral level. Emergency surgical spinal decompression was performed, resulting in immediate neurological improvement. The patient showed significant recovery and followed rehabilitation protocol. By the three-month follow-up, she was able to walk with assistance. Our case emphasizes the importance of considering SEH in patients presenting with new onset neurological deficits post-surgery, especially following neuraxial anesthesia attempts. Early diagnosis through MRI and timely surgical intervention are key to preventing permanent neurological damage and achieving favorable outcomes.

Key words: Regional anesthesia complications, Spinal anesthesia, Spinal epidural hematoma (SEH).