Acute postpartum paraplegia due to hemorrhagic cervicodorsal schwannoma mimicking neuraxial anesthesia complication: a case report

Background Acute paraplegia recognized following cesarean section under neuraxial anesthesia is a rare but alarming clinical presentation that requires urgent evaluation. Although neuraxial anesthesia–related complications are important considerations, structural spinal pathologies must be promptly excluded when neurological deficits persist. Hemorrhagic spinal schwannoma presenting acutely in the peripartum period is exceptionally uncommon and may clinically mimic a neuraxial anesthesia–related complication or spinal hematoma. Case presentation We report a 34-year-old previously healthy woman in whom complete paraplegia was first recognized after emergency cesarean section under spinal anesthesia. Neurological examination revealed complete flaccid paralysis of both lower limbs with a T4 sensory level and urinary retention. Urgent magnetic resonance imaging demonstrated a cervicodorsal intradural extramedullary lesion causing severe spinal cord compression. Emergency surgical decompression was performed. Intraoperatively, a hemorrhagic mass was identified, and histopathological analysis confirmed a schwannoma with extensive intratumoral hemorrhage. Postoperatively, the patient developed fever and inflammatory marker elevation; however, cerebrospinal fluid studies excluded central nervous system infection. Despite adequate surgical decompression, no meaningful neurological recovery was observed during the reported hospitalization, and the patient was referred for comprehensive neurorehabilitation. Conclusion Hemorrhagic spinal schwannoma is a rare but important cause of acute postpartum paraplegia that may temporally mimic a neuraxial anesthesia–related complication. The temporal association alone should not be interpreted as evidence of causality, particularly when the neurological lesion is anatomically remote from the site of neuraxial puncture. Persistent or atypical neurological deficits after cesarean delivery should prompt urgent spinal imaging to identify structural causes.