Spinal paralysis by extradural hematoma following catheter removal

A 63-year-man with lung cancer underwent right upper lobectomy under general anesthesia combined with thoracic epidural anesthesia. The surgical course was uneventfully completed. On the second postoperative day, he developed complete paralysis below T4 level 1 hour after removal of the epidural catheter. The magnetic resonance imaging (MRI) showed extradural hematoma compressing the spinal cord from T4 to T6 segments. Surgical removal of hematoma was scheduled. However, his neurological condition improved rapidly within a couple of hours, and the surgery was not carried out. The time course of recovery from complete paralysis suggests that extradural hematoma diffused into the extradural space, resulting in a decrease in the epidural pressure.