Expert: Dr Ian Jackson - please note UK based - 4/24/2008

Question
Ever since my epidural (at delivery) I have been having problems (2 year span)
No problems before giving birth. Epidural did not block my pain. Starting a few days afterwards, my hands were weak. I had trouble grasping and holding. This has persisted on and off for two years. I also have lower backache,foot tingling, extreme fatigue, some days worse than others. Epidual sight is painful to the touch. I have also had 2 bouts of eye trouble- sight jerky vision followed by a tired wierd feeling that has remained.
Checked for MS. MRI came back O.K.
Spinal x-ray came back O.K. Blood tests came back O.K.
Opthamologist report- no eye disease.
My question is- Can my symptoms be from the epidual? Could I have nerve damage? What should my next step be? Thank you in advance for any advise.


Answer
Nicole
First some important points
An epidural for pain relief during childbirth is usually inserted in your lower back around your lumbar spine. At the level it is inserted even if the anaesthetist was totally reckless and pushed the needle in too far amongst the nerves of your back the risks are still low of nerve damage. Furthermore even at the highest likely level used the area that could be affected by the needle is around your bikini line downwards and really mainly your legs.
So symptoms in other areas are more difficult to attribute to the epidural. The pain at the site of injection is quite possible from the epidural needle and there may have been a haematoma (bruise) there that has left some residual effect.
Now the only thing I can suggest is that the epidural needle may have caused a dural puncture. The Dura is the membrane that surrounds the spinal cord and contains the fluid that surrounds the nerves in your back. This fluid is cerebrospinal fluid and is produced in an area inside your brain and flows around your brain and down your spine acting as a cushion. A leak in this membrane can lead to headache, visual and hearing issues amongst other things.
Any leak usually heals within 7-10 days and then the patient feels better. This is a VERY long shot but it is possible that you may have a chronic leak from this membrane. I believe this is usually visible on MRI of they did an MRI of your lower back. However I think you would have to be looking for it.
Anyway it's a long shot but that is the only real mechanism I could see for the epidural being linked to your continuing problems.
Kind regards
Dr Ian Jackson