• Sunyoung Joo, Chung Reen Kim, and Sunyoung Kim.
• Department of Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Jeonha 1(IL)-dong, Dong-gu, Ulsan, Korea.
• Medicine (Baltimore). 2023 Nov 17; 102 (46): e35824e35824.

RationaleCaudal epidural block (CEB), which injects drugs into the epidural space through a sacral hiatus, is considered a safer alternative to other approaches. Serious complications, such as cauda equina syndrome or spinal cord infarction, have been reported very rarely, but their coexistence after CEB, which may be related to the ruptured perineural cyst, also known as a Tarlov cyst, was not reported.Patient ConcernsA 40-year-old male patient presented with bilateral lower extremity radicular pain. CEB was performed without image guidance. The patient exhibited sensory deficits below L2, no motor function (0-grade), hypotonic deep tendon reflexes, and no pathological reflexes.DiagnosesSpinal cord infarction, cauda equina syndrome, and sacral level perineural cyst with hemorrhage.InterventionHigh doses of steroids and rehabilitation were performed.OutcomesThe patient was discharged after 28 days with persistent bilateral leg paralysis and sensory deficits below the L2 level. The patient demonstrated no neurological improvement.LessonsMagnetic resonance imaging, including the sacral area, should be performed before performing CEB, to confirm the presence of a perineural cyst.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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