Neurotoxicity post-epidural anesthesia in a patient with Vitamin B12 deficiency: a case report

Abstract Background: Neurotoxicity have been reported after central neuraxial block. Some metabolic disturbances (thiamine deficiency, diabetes) were identified as contributing factor. Case presentation: We describe a young woman with vitamin B12 deficiency who developed persistent lower extremity weakness and hypoesthesia for weeks after epidural anesthesia. Initial examination revealed bilateral distal lower extremities weakness and decreased sensations. Serial neurologic examinations showed improved motor and sensory findings. An injected lumbosacral MRI was unremarkable. Vitamin B12 level was very low. The patient received physiotherapy and Vitamin B12 supplementation. Nerve conduction study and electromyography on day-23 post-epidural anesthesia revealed evidence of peripheral nerve injury. Conclusion: This case is the first to recognize vitamin B12 deficiency as a predisposing factor for the development of neurotoxicity following epidural anesthesia, it also emphasizes the importance of timely identification of vitamin deficiencies in patients developing neurotoxicity following central neuraxial blocks.