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Final Program


Final Program

Electrodiagnostic / Neuromuscular Medicine

1644 - Cauda Equina Syndrome Following Epidural Analgesia During Induction of Labor: A Case Report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • SM

    Shane V. McNamara, MD

    Resident Physician
    Johnson Rehabilitation Institute at JFK Medical Center
    New Brunswick, New Jersey, United States

    • Co-Author(s)

  • YM

    Yusuf Mahmoud, MD

    Resident
    Hackensack Meridian Health
    elmwood park, New Jersey, United States

  • GV

    George Vega, BS

    Medical Student
    Lake Erie College of Osteopathic Medicine
    Horseheads, New York, United States

  • JC

    Jennifer Chui, MD

    Spinal Cord Injury Medical Director
    JFK Johnson Rehabilitation Insititute
    Edison, New Jersey, United States

    • Submitter(s)

  • SM

    Shane V. McNamara, MD

    Johnson Rehabilitation Institute at JFK Medical Center
    New Brunswick, New Jersey, United States

Case Diagnosis: Cauda Equina Syndrome

Case Description: The patient is a 41-year-old female with a past medical history of hypertension and hyperlipidemia who underwent labor induction and subsequent cesarean section due to arrest of dilation. During labor, she received epidural analgesia with subsequent incomplete paraplegia, saddle anesthesia, and neurogenic lower urinary tract dysfunction. MRI Brain and Cervical/Thoracic/Lumbar Spine after delivery showed no acute abnormalities, and no surgical intervention was performed. Given her ongoing neurological deficits without imaging findings, electrodiagnostic testing was performed in acute rehabilitation. Electromyography (EMG) revealed fibrillations and decreased recruitment in all myotomes of the lower extremities, while Nerve Conduction Studies (NCS) showed low amplitude of bilateral tibial motor responses with normal conduction velocities, consistent with Cauda Equina Syndrome (CES). She demonstrated partial recovery of lower extremity strength and she was discharged home with a plan to continue intermittent self-catheterization.

Discussions:

This demonstrates a rare case of CES after epidural analgesia without MRI findings. Potential mechanisms include neurotoxicity from high local anesthetic concentrations, direct mechanical trauma, and inflammatory or ischemic injury. Clinicians should not exclude CES based solely on a normal MRI when paraparesis, sensory loss, and bladder dysfunction are present. It is necessary to utilize further diagnostic studies, such as EMG, to detect denervation and nerve root involvement. Early rehabilitation is recommended to maximize functional recovery. While MRI is the diagnostic gold standard of CES, MRI-negative CES has been increasingly recognized, particularly in cases of inflammatory and ischemic pathology. EMG and Nerve Conduction Studies are valuable in confirming the diagnosis of CES, with the highest sensitivity 2 to 3 weeks after symptom onset. 

Conclusions: CES is a rare but serious neurological complication of epidural analgesia that may present without radiologic abnormalities. This highlights the importance of clinical recognition and use of electrodiagnostic testing to allow for timely intervention and rehabilitation.