P006 Dystonia following neuraxial anesthesia to a patient with Ehlers-Danlos syndrome. A case report and literature review

<h3>Application for ESRA Abstract Prizes</h3> : I apply as an Anesthesiologist (Aged 35 years old or less) <h3>Background and Aims</h3> Neurological complications following neuraxial anesthesia are rare and can range from minor, self-limiting symptoms to permanent neurological deficits. We present a case of postoperative transient involuntary lower limb movements in a patient with Ehlers-Danlos syndrome (EDS) raising a diagnostic challenge to differentiate between severe complications, spinal myoclonus induced by neuraxial anesthesia and EDS manifestation. <h3>Methods</h3> Case presentation: A 46-year-old female known with EDS underwent hysteroscopy under spinal anesthesia with hyperbaric prilocaine 1%. The intraoperative course was uneventful. However, upon regression of the motor block, the patient developed involuntary, rhythmic, moderate frequency and amplitude, non-painful movements of both lower limbs (figure 1). These resolved spontaneously within two hours without any intervention. Informed consent for publication was obtained. <h3>Results</h3> Discussion: Given the acute onset, exclusion of serious causes such as spinal cord injury or epidural hematoma was prioritized. Following this, the differential diagnosis focused on spinal myoclonus after neuraxial anesthesia (SM-NA), and perioperative dystonia in EDS. With only 23 reported cases, SM-NA is a rare self-limited complication more frequently reported in women. Its proposed mechanism involves local anesthetic concentration gradients within the intrathecal space leading to segmental spinal disinhibition. In patients with EDS, dystonia has been attributed to peripheral injury or psychogenic movement disorder, making it challenging to diagnose and manage. <h3>Conclusions</h3> This case highlights that in patients with EDS, besides SM-NA, dystonia should also be included in the differential diagnoses following spinal anesthesia. Nevertheless, prompt exclusion of critical complications and detailed patient history are essential for appropriate management and reassurance.