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It Is Not Always the Epidural: A Case Report of Anterior Spinal Artery Ischemia in a Trauma Patient

Matos, Jennifer R., MD; George, Renuka M., MD; Wilson, Sylvia H., MD

doi: 10.1213/XAA.0000000000000764
Case Reports

Motor vehicle collisions impact millions of people annually resulting in multiinjury trauma. Anesthesiologists are consulted for rib fracture analgesia to improve respiratory mechanics and prevent intubation. This report describes a trauma patient who developed hypotension and lower extremity weakness after epidural placement for multiple rib fractures. Initially, hypotension was attributed to neuraxial sympathectomy. However, physical examination also indicated anterior spinal artery ischemia. Regional anesthesia and acute pain teams must be able to both identify contraindications and complications of regional techniques and discern when complications are not a result of regional interventions to initiate prompt management and definitive care.

From the Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.

Accepted for publication February 14, 2018.

Funding: None.

The authors declare no conflicts of interest.

This case was presented at the 2017 Regional Anesthesia and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine in San Francisco, CA, April 6–8, 2017.

Address correspondence to Jennifer R. Matos, MD, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave, Suite 301, MSC 912, Charleston, SC 29425. Address e-mail to

© 2018 International Anesthesia Research Society
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