Introduction:

Neurological complications as a consequence of spinal anesthesia have been frequently reported due to its extensive use, which can cause toxic myelopathy.

Case Presentation

A 26-years-old patient with a health history was admitted to the Freyre de Andrade Clinical Surgical Hospital 24 hours after surgery for hemorrhoids with spinal anesthesia (hyperbaric lidocaine). It begins with right palpebral ptosis and difficulty walking. She was discharged and two days later she was admitted with drowsiness and stiff neck with positive CSF and suspected meningoencephalitis. She evolves into a coma with no satisfactory response to antibiotics for 14 days. Cerebral edema, autonomic disorders, alternating hemiparesis, and flaccid paraplegia are noted. The antibiotic was withdrawn and she was treated with parenteral betamethasone for two months plus physiotherapy for 10 months. She had progressive improvement and almost total recovery. All serum and cerebrospinal fluid microbiological studies were normal.

Discussion:

Dissimilar neurological injuries have been reported by spinal anesthesia that include 3 syndromes: meningoencephalitis, cranial nerve injury and paraparesis (plegia). This case had 3 types of lesions plus cerebral edema.

Conclusions:

The association of the three syndromes is infrequent since we did not find the same case in databases. Resolution with betamethasone is a therapeutic aspect to consider in similar cases

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