NEUROLOGY 2008;71:e1
© 2008 American Academy of Neurology
Resident and Fellow Section
Teaching NeuroImage: Acute spastic monoplegia secondary to spinal epidural venous engorgement in pregnancy
Michael J. Franco,
Martina Vendrame, MD, PhD,
Zulfi Haneef, MD, MRCP and
S. Ausim Azizi, MD, PhD
From Temple University, Philadelphia, PA.
Address correspondence and reprint requests to Dr. Martina Vendrame, Temple University Hospital, Neurology Department, 3401 North Broad Street, Parkinson Pavilion Suite 558, Philadelphia, PA 19140 vendrame{at}temple.edu
A 20-year-old, 33-week-pregnant woman presented with 2 days of backache and left leg weakness. She denied sphincter or sensory disturbance. Examination revealed proximal left leg weakness, bilateral hyperreflexia, and extensor plantars. A cesarean section was performed 5 days later. Two days postpartum, neurologic examination results returned to normal. Spine/abdomen MRIs before (figure, A–C) and after (figure, D–F) are presented.
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Figure Spine/abdomen MRIs pre- and postpartum
(A) T2-weighted MRI of thoracic and lumbar spine revealing prominent epidural and paravertebral vessels in the lower thoracic and lumbar spinal canal consistent with vascular congestion. (B) Transverse T2-weighted image of the cord at level of T12-L1 showing increased signal, likely representing cord edema (white arrow). (C) MRI of the abdomen highlights compression of the inferior vena cava (IVC) (white arrow). (D) Repeated T2-weighted MRI of thoracic and lumbar spine showing resolution of vascular congestion. (E) Repeated transverse T2-weighted image of the cord at level of T12-L1 showing absence of the previously noted hyperintensity (white arrow). (F) MRI of the abdomen showing resolution of the IVC compression (white arrow).
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Increased blood flow to the epidural venous plexus occurs due to compression on the inferior vena cava (IVC) by the pregnant uterus or by increased abdominal pressure.1 This may present as acute spastic paraparesis, but may also be asymptomatic,2 which can be explained by the severity of IVC compression. MRI is helpful in excluding cord pathology, assuring favorable outcome.
Disclosure: The authors report no disclosures.
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REFERENCES
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- Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T. Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging. Br J Anaesth 1997;78:317–319.[Abstract/Free Full Text]
- Takiguchi T, Yamaguchi S, Tezuka M, Furukawa N, Kitajima T. Compression of the subarachnoid space by the engorged epidural venous plexus in pregnant women. Anesthesiology 2006;105:848–851.[Medline]
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