Transient aphonia and quadriplegia during epidural anesthesia

A patient is presented who developed unusual neurologic findings outside the area of epidural anesthesia. The deficit consisted of aphonia and flaccid paralysis of both upper extremities. Because the exact level of the epidural anesthesia could not be determined, the paralysis of the upper extremities could be attributed to the direct effect of the anesthetic reaching a spinal level of C5. The quadriparesis was of a very short duration, suggesting a transient ischemic attack in the vertebrobasilar vascular system, most likely secondary to the hypotension that occurred during the procedure.