• Tibor Boco and Harel Deutsch.
• Department of Neurosurgery, Rush University Medical Center, Chicago, IL 60612, USA. tibor_boco@rush.edu
• Spine. 2007 Oct 15;32(22):E649-51.

Study DesignThe authors present a case report of a 70-year-old woman who presented with delayed symptoms of epidural hematoma after epidural catheter anesthesia.ObjectiveWe intend to report a unique case of delayed presentation of epidural hematoma after epidural catheter anesthesia.Summary Of Background DataThe authors present a case of a 70-year-old woman who received epidural anesthesia via spinal catheter infusion before right knee replacement surgery. After an unremarkable postoperative course, she presented 6 weeks later with worsening middle and lower back pain, prompting a workup and lumbar MR imaging. MRI of her lumbar spine demonstrated a lower thoracic epidural fluid collection with significant radiographic mass effect on the thoracic spine. The fluid was diagnosed as chronic breakdown of an initially asymptomatic epidural hematoma. Symptomatic epidural hematoma formation after epidural block is rare but commonly reported in the literature. The incidence of asymptomatic hematoma formation is probably much higher and unrecognized.MethodsThis is a retrospective review of a case seen at our institution.ResultsA persistent epidural fluid collection in a normocoagulable patient presenting with symptoms of back pain more than a month after spinal block has not been reported in the literature.ConclusionIn the absence of focal neurologic symptoms, conservative therapy and observation are appropriate.

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