{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:27:21Z","timestamp":1787776041314,"version":"build-2784847793"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This case report aims to discuss the prompt recognition and the possible mechanism of acute cauda equina syndrome (CES) following intrathecal bupivacaine administration for cesarean section. A 30-year-old primigravida developed sudden-onset bilateral lower-extremity weakness, numbness, and paresthesia, along with urinary and bowel incontinence, after an uncomplicated cesarean delivery under spinal anesthesia. Magnetic resonance imaging revealed engorgement and gadolinium enhancement of the cauda equina nerve roots, consistent with a diagnosis of CES. The patient was immediately started on high-dose intravenous steroids and intrathecal triamcinolone, followed by intensive inpatient rehabilitation. However, despite maximal medical treatment, the patient exhibited only minimal improvement, with persistent neurological deficits and dysfunction. This case highlights the importance of maintaining a high index of suspicion for CES following intrathecal bupivacaine administration and the need for prompt recognition and multidisciplinary management to optimize maternal outcomes. Understanding the potential mechanisms underlying bupivacaine-induced neurotoxicity, including direct nerve toxicity, vascular changes, and synergistic effects, may guide the development of targeted therapeutic strategies to mitigate this devastating complication. Early spinal imaging, high-dose steroid therapy, and a collaborative approach involving obstetrics, anesthesiology, neurology, and rehabilitation services are crucial for the successful management of acute CES.<\/jats:p>","DOI":"10.4103\/ant.ant_113_0032","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T11:00:45Z","timestamp":1747393245000},"page":"98-101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Acute Cauda Equina Syndrome Following Spinal Anesthesia During Cesarean Section: A Case Report"],"prefix":"10.4103","volume":"34","author":[{"given":"Shin-Rung","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Hao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"R1-20250613","doi-asserted-by":"crossref","first-page":"4665","DOI":"10.3390\/ijms24054665","article-title":"Spinal cord injury and complications related to neuraxial anaesthesia procedures:A systematic review","volume":"24","author":"Pozza","year":"2023","journal-title":"Int J Mol Sci"},{"key":"R2-20250613","first-page":"e49886","article-title":"Risk factors in administering spinal anesthesia:A comprehensive review","volume":"15","author":"Doelakeh","year":"2023","journal-title":"Cureus"},{"key":"R3-20250613","doi-asserted-by":"crossref","first-page":"e0693","DOI":"10.1097\/MD.0000000000010693","article-title":"Cauda equina syndrome following an uneventful spinal anesthesia in a patient undergoing drainage of the Bartholin abscess:A case report","volume":"97","author":"Merino-Urrutia","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"R4-20250613","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/00115550-200509000-00008","article-title":"Neurotoxicity of intrathecally administered bupivacaine involves the posterior roots\/posterior white matter and is milder than lidocaine in rats","volume":"30","author":"Takenami","year":"2005","journal-title":"Reg Anesth Pain Med"},{"key":"R5-20250613","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1001\/archneur.1964.00460150078008","article-title":"Paraplegia following spinal anesthesia. 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