Atypical Distribution of Upper Thoracic Epidural Local Anesthetic: Case Report.

Spread of drugs in the epidural space may be unpredictable. The differential diagnosis of unilateral hemiparesis could be due to the unilateral spread of the drug, spinal epidural hematoma, intraspinal hematoma, and spinal cord injury. Atypical distribution of local anesthetic can occur due to lateral displacement of the epidural catheter, patient positioning, or the presence of an epidural septum. We present a case of atypical spread of epidural local anesthetic causing hemiparesis. It emphasizes the need for careful monitoring of sensory levels on both sides and provides insight into the causes of unilateral drug spread in the epidural space.