Hemorrhage into an Occult Spinal Ependymoma after Epidural Anesthesia

Summary of Background Data: Five cases of hemorrhage into a spinal neoplasm after spinal or epidural anesthesia are reported in the literature. Presentation ranges from severe low back pain to acute cauda equina syndrome. Methods: A case study of a patient who hemorrhaged into an intradural, extramedullary spinal cord mass was performed. A detailed literature review is also provided. Results: A 27 year old female underwent epidural anesthesia for Cesarean section delivery. She presented with a 3 week history of increasing low back pain with bilateral radiculopathy. Imaging studies revealed a large hemorrhagic intradural mass compressing the lower conus medullaris and cauda equina, which operatively was confirmed to be a myxopapillary ependymoma. Conclusions: We report a case of hemorrhage into a previously unrecognized ependymoma after epidural anesthesia. Underlying tumors may rarely complicate regional anesthesia in the lumbar spine.