article · The Egyptian Journal of Neurology Psychiatry and Neurosurgery
A 34-year-old woman developed complete paraplegia, urinary retention, and a T4 sensory deficit following an emergency caesarean section performed under spinal anaesthesia. Although persistent deficits after neuraxial procedures frequently raise suspicion of anaesthetic complications or haematomas, urgent magnetic resonance imaging identified a cervicodorsal intradural extramedullary mass causing severe spinal cord compression. Emergency decompression surgery revealed a haemorrhagic tumour, which histopathological analysis confirmed to be a schwannoma with extensive intratumoral bleeding. Postoperatively, the patient exhibited raised inflammatory markers and fever, though cerebrospinal fluid testing excluded central nervous system infection. Despite successful surgical decompression, the patient did not achieve meaningful neurological recovery during the reported hospitalisation and was referred for comprehensive neurorehabilitation. The findings demonstrate that structural spinal cord lesions located distant from the anaesthetic puncture site can trigger sudden peripartum neurological collapse.
Postpartum neurological deficits are often reflexively attributed to anaesthetic complications, risking dangerous diagnostic delays. This case demonstrates that silent spinal tumours can acutely haemorrhage during the peripartum period and cause severe paralysis. Ensuring that clinicians immediately investigate atypical neurological deficits with spinal imaging helps teams rapidly identify non-anaesthetic structural causes and make informed decisions regarding urgent neurosurgical intervention.
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Abstract Background Acute paraplegia recognized following cesarean section under neuraxial anesthesia is a rare but alarming clinical presentation that requires urgent evaluation. Although neuraxial anesthesia–related complications are important considerations, structural spinal pathologies must be promptly excluded when neurological deficits persist. Hemorrhagic spinal schwannoma presenting acutely in the peripartum period is exceptionally uncommon and may clinically mimic a neuraxial anesthesia–related complication or spinal hematoma. Case presentation We report a 34-year-old previously healthy woman in whom complete paraplegia was first recognized after emergency cesarean section under spinal anesthesia. Neurological examination revealed complete flaccid paralysis of both lower limbs with a T4 sensory level and urinary retention. Urgent magnetic resonance imaging demonstrated a cervicodorsal intradural extramedullary lesion causing severe spinal cord compression. Emergency surgical decompression was performed. Intraoperatively, a hemorrhagic mass was identified, and histopathological analysis confirmed a schwannoma with extensive intratumoral hemorrhage. Postoperatively, the patient developed fever and inflammatory marker elevation; however, cerebrospinal fluid studies excluded central nervous system infection. Despite adequate surgical decompression, no meaningful neurological recovery was observed during the reported hospitalization, and the patient was referred for comprehensive neurorehabilitation. Conclusion Hemorrhagic spinal schwannoma is a rare but important cause of acute postpartum paraplegia that may temporally mimic a neuraxial anesthesia–related complication. The temporal association alone should not be interpreted as evidence of causality, particularly when the neurological lesion is anatomically remote from the site of neuraxial puncture. Persistent or atypical neurological deficits after cesarean delivery should prompt urgent spinal imaging to identify structural causes.
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DOI: 10.1186/s41983-026-01227-9
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