Acute transverse myelitis arising after combined general and thoracic epidural anesthesia

Acute transverse myelitis after surgery is a rare condition, but this complication is devastating. The relationship between anesthetic procedures and acute transverse myelitis is controversial. A 46-year-old woman was scheduled a colostomy closure, and general anesthesia with thoracic epidural anesthesia was performed. Epidural catheter was inserted at the T10–11 interspace, and insertion was smooth, and no blood or cerebrospinal fluid leakage was seen. However, 28 h after the surgery, the patient complained motor, sensory, and autonomic dysfunction. Two days after onset, a magnetic resonance imaging study demonstrated intramedullary hyperintensity, particularly in the gray matter, extending from T5–T9 and then diagnosed with acute transverse myelitis followed by the several examinations. High-dose IV methylprednisolone treatment was initiated and neurologic function restored 2 months after onset. Transverse myelitis may unpredictably occur following surgery. We are not able to determine the pathogenic relationship between anesthesia and myelitis with certainty, but proper diagnostic approach to myelitis may improve the prognosis.