37 yo primip. Hx MS for 10 yrs, 1 acute exacerbation ~ 1.5 yrs ago resulting in severe weakness t-6 down for approx 8 weeks. Treated with high dose steroids. Weakness resolved, pt returned to near normal function, and ran 8-12 miles per week through-out most of pregnancy. Pt is 5'6", 155# before delivery, takes Immuran for MS, no other meds., no other medical problems.
Spontaneous onset of labor, membranes ruptured at home, presented to hospital 4cm dilated, actively contracting. Resident called to place epidural. First attempt resulted in wet tap. Catheter subsequently placed one level above first attempt. 3 cc test dose resulted in t4 sensory level, complete abatement of contractions. 4 hours later with pitocin, contractions returned, baby delivered vaginally with vacuum. Block level now t10. Saline infusion started through epidural catheter as prophylactic treatment for PDPH. Pt taken to post-partum.
4 hours post delivery, pt begins to complain "I don't feel right". Exam reveals tense abdomen, resp. rate 20, toes clenched, feet extended, legs rigid.

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