Presentation of Cauda Equina Syndrome in the immediate post-natal period   EP 1102

Ms Victoria Wright, Dr Rajni Chauhan, Dr Elizabeth Birch

 

Objective 

This is an interesting case of Cauda Equina syndrome in a patient with a pre-existing spinal injury.

Early recognition and urgent surgical intervention were crucial in preventing long term disability.

This emphasises the heightened awareness of neurological complications postpartum especially in woman with prior spinal trauma

 

Case Report 

A 28-year-old Gravida 2 Para 1. Induced at 37 weeks for small for gestational age. Previous preterm vaginal delivery following preterm premature rupture of membranes at 35 weeks' gestation.

 

Discussion

 This case highlights the challenges of diagnosing neurological complications in pregnancy and the importance of the multidisciplinary team.

 Her initial symptoms could have been mistaken for post spinal effects (temporary nerve blockade) or postpartum bladder atony, which is common after vaginal delivery with a postpartum haemorrhage.

 In this case, rapid progression of symptoms required an urgent MRI and surgical decompression as Cauda Equina is a neurological emergency requiring intervention within 48 hours for the best chances of recovery.  

 This case emphasises that Cauda Equina must be suspected in postpartum women with persistent numbness, weakness or incontinence and symptoms should not be attributed solely to spinal or postpartum bladder dysfunction.

 In women with pre-existing spinal injuries, risk of Cauda Equina is increased and should have anaesthetic assessment antenatally. Postpartum haemorrhage may worsen spinal ischaemia contributing to nerve dysfunction.  

 

Conclusion

This case highlights the importance of an early risk assessment, multidisciplinary collaboration and timely escalation in the management of pregnant women with pre-existing spinal conditions.

A neurological assessment antenatally may have helped anticipate complications related to labour and choice of anaesthesia.