Spinal metastases from choriocarcinoma presenting with neurological symptoms suggestive of neuraxial complication in the postpartum period.

We present the case of a 28-year-old woman who developed lower back pain and right-sided lower limb paraesthesia 2 weeks after an uncomplicated vaginal birth at term facilitated by epidural analgesia for labour. Initial assessment suggested postpartum nerve injury and a locally developed flow chart for the management of postpartum neurological symptoms was used to guide investigation. Urgent magnetic resonance imaging revealed widespread spinal and systemic lesions consistent with metastatic disease. Subsequent markedly elevated human chorionic gonadotropin confirmed a diagnosis of postpartum choriocarcinoma. Early recognition of red flag symptoms and adherence to a structured pathway enabled rapid diagnosis and timely oncological management.