Neurologic symptoms during recovery from spinal anesthesia may reflect residual neuraxial block, but severe pain or persistent motor block can also indicate a compressive neuraxial emergency. A 49-year-old man underwent right knee arthroscopic surgery under spinal anesthesia with 14 mg of 0.5% hyperbaric bupivacaine. The neuraxial procedure was uncomplicated, and perioperative coagulation status was normal. At 225 minutes after intrathecal injection, he developed severe bilateral lower-extremity tightening and twisting pain extending to the buttock/saddle region, with Medical Research Council grade 0 motor strength in bilateral hip, knee, and ankle movements. Gross distal sensation in both feet was documented as present. Because cauda equina syndrome, spinal epidural hematoma, or another acute compressive neuraxial lesion could not be excluded clinically, urgent lumbosacral magnetic resonance imaging was obtained. Magnetic resonance imaging demonstrated left-sided disc extrusion at L4-L5 and L5-S1 with compression of the left L4 and S1 nerve roots; no epidural hematoma, central canal compression, or acute cauda equina compression was reported. The patient was managed conservatively with close observation and symptomatic treatment. Motor function recovered within hours, and at outpatient follow-up 29 days after surgery, no specific abnormality was documented. Severe bilateral leg pain with persistent motor block after spinal anesthesia should prompt structured neurologic reassessment and urgent imaging when compressive neuraxial pathology cannot be excluded clinically.

We present the case of a 33 year old patient who has been followed since the age of 16 for autosomal dominant spondyloepiphyseal dysplasia (SED), in an evocative familial context (his sister has the same clinical picture). The disease began in adolescence with disabling mechanical pain in the hips and knees, with a walking distance limited to 500 metres. Clinical examination showed bilateral knee flexion contracture, generalised stiffness of the hips, shoulders, elbows, wrists and fingers, girdle muscle wasting, and a BMI of 16 (47 kg for 1.67 m). The patient walks with a cane. Symptomatic treatment combining analgesics, NSAIDs and physiotherapy was initiated. The article details the diagnostic arguments, indications for bilateral hip arthroplasty, anaesthetic precautions and the role of genetic counselling. Medium term outcome was favourable, with improvement in pain and walking distance after total hip replacement.

Antenatal care (ANC) is important care or attention given to a pregnant mother to ensure safety of the mother and child from time of conception to delivery. Antenatal care is the medical attention, monitoring, education, and support given to a pregnant woman from conception until the onset of labor. However, certain factors may hinder the smooth take up of the ANC. Therefore, barriers to antenatal booking are factors that delay or prevent pregnant women from registering for antenatal care (ANC), especially within the first trimester in rural areas. These barriers are usually interconnected. This study aimed to Assesse the Barriers to Early Antenatal Booking Among Women of Reproductive Age in Rural Areas of South-South, Nigeria. This was a cross-sectional study involving 250 pregnant women. Participants’ age is between 18 to 47 years. A well-structured questionnaire was administered to participants. The study lasted for a period of 3 months. Statistical analysis was done using SPSS version 25.0 and p < 0.05 was significant. The results revealed that 76% of the pregnant women are not aware that antenatal care should start in the first trimester of pregnancy, 72% are not aware that early antenatal booking helps detect pregnancy complication, 76% are prevented from early ANC booking due to cost, 68% is due to lack of money, 80% had low level of education, 80% prefer traditional birth attendants, poor roads, long waiting time, cultural belief, and permission from husband. The study revealed that educational and awareness barriers, sociocultural barriers, geographical and transportation barriers, socioeconomic barriers, health system–related barriers, psychosocial factors, pregnancy-related factors are major barriers to early ANC booking in rural areas.